Host Cornea Preparation

The host preparation involved making a 3.2 mm clear corneal incision and two side ports. Descemetorhexis, inferior peripheral iridotomy and graft insertion using a Geuder injector was performed similar to the previously described technique for DMEK.5,15

Mi-OCT was used at various stages during this procedure. Before commencing the surgery, the posterior stroma/DM was assessed for presence of any focal abnormalities such as DM scar, prominent DM fold, and areas of missing DM. Also, areas of peripheral anterior synechiae as well as inner edge of the previous surgical scar were screened. This helped in better planning of the surgical site. After the descemetorhexis, Mi-OCT was used to screen the entire posterior corneal surface for any retained DM tags. (Figure 2A and ​andB)B) Scoring and peeling were avoided in areas of missing Descemet membrane, delineated on Mi-OCT, in cases of complicated pseudophakic bullous keratopathy (PBK) to avoided undue damage to the corneal stroma.

Intraoperative images (A) showing retained DM tag (marked with red arrow) after descemetorhexis; (B) removal of a retained DM tag with intravitreal forceps.