PMC4216047_01
Stages of the "rescue" maneuver.. Notes: (A) The cannula tip is positioned halfway into the lumen of the tightly rolled Descemet membrane endothelial keratoplasty graft. (B) A small air bubble is injected in a slow and controlled fashion. Note that the bubble is not round, but is nearly cylindrical, conforming to the roll's lumen, due to the high resistance of the graft to being unfolded. (C) The expanding air bubble unfolds the roll. (D) The graft forms a "taco" around the air bubble, with its opening facing the anterior chamber angle. (E) The graft is centered by gently sweeping it with the cannula under the bubble. (F) After removing the air bubble anterior to the graft, another air bubble is injected under the graft in order to lift it against the recipient's cornea.
opth-8-2161Fig1.jpg
PMC4216047_01_opth-8-2161Fig1.jpg
f1-opth-8-2161
In a further attempt, a 30 gauge cannula connected to an air-filled tuberculin syringe was positioned inside the roll's lumen (Figure 1A), and air was slowly injected in order to achieve a controlled opening up of the roll (Figure 1B and C), until it assumed a "taco" configuration around the bubble, with its opening facing the anterior chamber angle (Figure 1D). Then, using a 30 gauge cannula (DMEK surgical disposable set; D.O.R.C.), the graft's periphery was pressed against the iris and centered by sweeping the graft over the iris (Figure 1E). Finally, the air between the graft and the host cornea was removed and the graft was appositioned against the cornea by injection of another air bubble posterior to the graft (Figure 1F).