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Mohammed M. Abusayf, MD
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This case involves a 30-year-old woman who sustained ocular trauma in childhood and underwent penetrating keratoplasty (PK), vitrectomy, and cataract extraction with IOL implantation over a decade ago. She presented with persistent epithelial defects, reduced vision, and contact lens dependence for the last 2 years. Examination revealed a failed graft, an extremely deep anterior chamber, and IOL-iris adhesions—all of which contributed to the surgical complexity..
This video demonstrates Descemet membrane endothelial keratoplasty (DMEK) performed beneath the PK graft. Donor preparation is shown using the modified standard no-touch technique; two marking methods were employed in anticipation of potential intraoperative challenges—particularly relevant in post-PK and post-vitrectomy settings.
The descemetorhexis is confined within the graft diameter to avoid compromising the graft–host junction. The Endoglide is employed for endothelium-in-graft delivery via a pull-through approach. Air escape following Endoglide removal resulted in slight decentration; however, forceps-assisted delivery maintained graft control. The graft is successfully recentered, underscoring the importance of maintaining its position within the rhexis to reduce the risk of detachment. The video also demonstrates techniques to identify and manage intraoperative graft folds.
At 4:38, the on-screen text says “gas,” but air was actually used throughout the surgery—except at the end, where 20% SF6 was used for the final tamponades.
Posted: 4/22/2025
Mohammed M. Abusayf, MD
This case involves a 30-year-old woman who sustained ocular trauma in childhood and underwent penetrating keratoplasty (PK), vitrectomy, and cataract extraction with IOL implantation over a decade ago. She presented with persistent epithelial defects, reduced vision, and contact lens dependence for the last 2 years. Examination revealed a failed graft, an extremely deep anterior chamber, and IOL-iris adhesions—all of which contributed to the surgical complexity..
This video demonstrates Descemet membrane endothelial keratoplasty (DMEK) performed beneath the PK graft. Donor preparation is shown using the modified standard no-touch technique; two marking methods were employed in anticipation of potential intraoperative challenges—particularly relevant in post-PK and post-vitrectomy settings.
The descemetorhexis is confined within the graft diameter to avoid compromising the graft–host junction. The Endoglide is employed for endothelium-in-graft delivery via a pull-through approach. Air escape following Endoglide removal resulted in slight decentration; however, forceps-assisted delivery maintained graft control. The graft is successfully recentered, underscoring the importance of maintaining its position within the rhexis to reduce the risk of detachment. The video also demonstrates techniques to identify and manage intraoperative graft folds.
At 4:38, the on-screen text says “gas,” but air was actually used throughout the surgery—except at the end, where 20% SF6 was used for the final tamponades.
Posted: 4/22/2025
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