Rescue technique for a partially expulsed descemet membrane endothelial keratoplasty (DMEK) graft

Abstract

Purpose: To describe a novel surgical technique to rescue a partially expulsed DMEK graft after insertion. Observations: We present a case of a 66-year-old woman with visually significant Fuchs endothelial dystrophy who underwent a DMEK surgery complicated by partial expulsion of the DMEK graft during insertion. To rescue the graft, MicroSurgical Technology (MST) forceps were inserted through a nasal paracentesis to grasp the DMEK graft and redirect it back into the anterior chamber. The surgical technique and postoperative outcomes are described. The partially expulsed graft was centered and attached successfully during surgery. Postoperatively, the patient required two rebubbling procedures, but achieved best-corrected visual acuity of 20/20 vision 1 month after surgery. Conclusions: and Importance: We describe an underreported complication and present a novel rescue technique for a partially expulsed DMEK graft that is effective and minimizes manipulation of the graft. Keywords: DMEK, Expulsed graft, Rescue technique