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In this study we examined the use of intraoperative Ultrasound Biomicroscopy (UBM) for the determination of graft orientation during Descemet's membrane endothelial keratoplasty (DMEK)
Prospective interventional study done in a university hospital. Patients: Five patients that underwent DMEK surgery due to corneal endothelial insufficiency .Following the identification of correct graft status using 'Blue cannula tip' sign (AKA 'Moutsouris Sign') UBM was used to ascertain graft's orientation. Main outcome measures included the intraoperative feasibility of the technique in the intraoperative setting, and the postoperative orientation as demonstrated by anterior segment optical coherence tomography (AS-OCT). Intra- and postoperative complications, postoperative clearance of the cornea, corrected distance visual acuity and endothelial cell loss were also noted.
In all cases the technique allowed the determination of the orientation of the graft. In two cases UBM identified a upside-down graft. In one of these cases, 'blue cannula tip' showed correct orientation while UBM identified an upside-down graft. The graft was flipped using fluid jets, and repeat 'blue cannula tip', and UBM both showed correct orientation. In all cases postoperative OCT demonstrated correct graft orientation. In one case, which had significant posterior surface irregularities, the graft partially detach, despite repeat rebubbling attempts, and DSAEK was done. The other grafts cleared during the 1st postoperative month, and endothelial cell loss rate ranged between 40-52%.
Intraoperative UBM is a simple and effective tool for determining graft orientation during DMEK, possibly obviating the need for other techniques and devices currently used this purpose
This presentation is from the session "SPS-101 Corneal Procedures & Diagnostics: EK, PK, CXL, Other" from the 2020 ASCRS Virtual Annual Meeting held on May 16-17, 2020.