EyeWorld Asia-Pacific March 2018 Issue

20 EWAP FEATURE March 2018 bubble to stain the graft and scis- sors finish the dissection. The graft is then loaded into an injector. Various eye banks are already producing PDEK grafts, making it possible for the surgeon to only have to stain the graft with trypan blue and load it into the injector, Dr. Agarwal said. For transplant, Dr. Agarwal stressed the importance of using a trocar anterior chamber maintain- er. With air on via the AC main- tainer, perform the descemetorhex- is, scoring, and stripping with a reverse Sinskey hook. Once the patient’s Descemet’s is removed, turn the air off for insertion of the graft. Once it begins to unroll, inject air so the graft sticks against the overlying stroma, restarting air infusion afterward, Dr. Agarwal ex- plained. Use a reverse Sinskey hook to spread out the graft, smoothing wrinkles. “If you are an endothelial kera- toplasty surgeon—or even if you are not—you can certainly learn PDEK,” Dr. Agarwal said, adding that there are some minor surgi- cal differences when compared to DSEK and DMEK and reiterat- ing the importance of a trocar AC maintainer in PDEK cases. Dr. Agarwal said PDEK can be performed in all cases requiring some form of EK, including previ- ously failed grafts. In November 2017, Dr. Agarwal published the first book on PDEK, which includes the various ways of how to surgi- cally perform the procedure and the surgical techniques, such as a glued IOL or iris repair with his relatively new four-throw pupillo- plasty technique. 4 Primary descemetorhexis As in PDEK, DMEK, and D SEK, be- fore a graft can be inserted into the recipient eye, the patient’s Descem- et’s membrane must be stripped off. But what if it were left that way, stripped and with no graft? About 5 years ago, small case reports started to be published about failed DMEK grafts that spontaneously cleared in Fuchs’ pa- tients, use of a rho-kinase inhibitor to clear the cornea without a graft, and deliberate descemetorhexis without a graft with mixed results. 5–8 This research had Dr. Colby testing the technique of a primary descemetorhexis in 2014 on one of her long-term Fuchs’ patients who Alternative - from page 19 I-Ring® Pupil Expander A Gentle and Safe Small Pupil Expansion Solution • Circular ring expands iris uniformly, relieving specific stress points • Reduces iris trauma and quickly returns to natural shape, post-surgery • Allows for easy insertion and removal — Harvey Uy, MD Peregrine Eye and Laser Institute Makati, Philippines “As a cataract and retina surgeon, I have found the I-Ring to consistently produce round, intact postoperative pupil margins. ” Concerned About Iris Trauma? Call your local sales rep or customer service at 1-866-906-8080 For clinical information visit iring.net For information on our complete line products, visit beaver-visitec.com