Chamber shallowing technique for challenging DMEK cases: Tucking cellulose spears under the speculum to augment posterior pressure

• Published in: Indian journal of ophthalmology Vol. 72; no. Suppl 3; pp. S533 - S535
• Main Authors: Kam, Yong, Kigin, Matthew, Rosenberg, Eric D, Blitzer, Andrea, Sales, Christopher S
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01-05-2024; Medknow Publications & Media Pvt. Ltd; Wolters Kluwer - Medknow; Wolters Kluwer Medknow Publications
• Subjects: Anterior chamber; Anterior Chamber - surgery; Cellulose; cellulose sponge; chamber depth; Cornea; Corneal transplantation; Descemet Stripping Endothelial Keratoplasty - methods; Diaphragm; dmek; Endothelium; Eye lens; Eye surgery; Eyelid; Humans; Intraocular Pressure - physiology; Iris; Medical research; Medicine, Experimental; Methods; Myopia; Physiological aspects; posterior pressure; Surgical Technique; tap technique; Transplantation; Visual Acuity; United States
• ISSN: 0301-4738; 1998-3689; 1998-3689
• DOI: 10.4103/IJO.IJO_1385_23

Some anterior chambers do not readily shallow because of insufficient posterior pressure and/or very deep anterior chamber anatomy, which can make unscrolling descemet membrane endothelial keratoplasty (DMEK) tissue more challenging with an unmodified tap technique. We present a hands-free method for augmenting posterior pressure by temporarily tucking cellulose sponges under the blades of the eyelid speculum. The sponges transfer some of the eyelid speculum's weight onto the bulbar surface posterior to the iris, thereby indenting the sclera and causing the iris diaphragm to bulge further forward. This hands-free technique can transform a potentially challenging DMEK case into a more straightforward one by facilitating both a shallow anterior chamber and a bimanual unscrolling technique. However, it only works in bicameral eyes with a vitreous body (e.g., an eye with penetrating keratoplasty, vitreous syneresis, and axial myopia) and will not work in unicameral eyes after vitrectomy (e.g., an eye with an Anterior Chamber Intraocular Lens (ACIOL)).