The "yogurt" Technique for Descemet Membrane Endothelial Keratoplasty Graft Preparation: A Novel Quick and Safe Method for Both Inexperienced and Senior Surgeons

Abstract

Purpose:To describe and evaluate the efficacy and safety of a novel technique to prepare Descemet membrane endothelial keratoplasty (DMEK) donor grafts using a newly designed partial-thickness hinge punch.Methods:The novel punch has a circular guarded blade missing 1 clock hour, creating an uncut hinge on the donor cornea. In addition, 2 straight cuts are made by the punch perpendicular to the edge of trephination toward the trabecular meshwork in the hinge area. After the donor corneoscleral rim is positioned endothelial side up, a partial-thickness trephination is performed avoiding any rotational movements. Descemet membrane is lifted from Schwalbe line in the hinge area, and DMEK graft is peeled after desired marking without further preparation.Results:Three surgeons of different experience levels on DMEK (senior/independent/fellow) initially applied the new technique in 18 research corneas, divided into equal groups. Two failures in graft preparation were noted, defined as radial tears extending ≥0.5 mm. The mean preparation time was 6.21 ± 1.45 minutes. No statistically significant differences were noted in success rate, duration, and endothelial cell loss (ECL) between surgeons (P > 0.05). ECL was evaluated as an average of 5 readings on randomly selected graft areas, not including graft periphery. Fifteen additional research corneas were stripped by 1 single user in an eye bank setting. No tissue loss was recorded, whereas ECL and mortality rate remained unaffected after preparation (P = 0.64 and P = 0.72, respectively).Conclusions:This new DMEK graft preparation technique, simulating the opening of a yogurt cup, seems to be a safe and an efficient method, providing shorter preparation time and low failure rates independent of surgeon's experience level.