Double-Bubble Technique in Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes: A Case Series

PURPOSE:To describe a modified technique for Descemet membrane endothelial keratoplasty (DMEK) in vitrectomized eyes that had undergone transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) and pars plana vitrectomy. METHODS:This was a prospective interventional case series. Patients exhibiting endothelial dysfunction with aphakia, or dislocated IOLs, who underwent IOL-suture and pars plana vitrectomy, were enrolled. Patients underwent DMEK using the “double-bubble technique,” which is characterized by the placement of 2 bubbles, 1 above and 1 beneath the graft. One small air bubble is placed over the graft for the purpose of unfolding the graft; the other large bubble is injected under the graft to enable fixation of the graft. Best spectacle-corrected visual acuity, central corneal thickness, endothelial cell density, the time of graft unfolding (using a surgical video), and the incidence of intraoperative/postoperative complications were analyzed. RESULTS:This study included 6 eyes of 6 patients (3 men and 3 women; mean age 78.0 ± 2.5 years). Although the unfolding time was relatively long (10.1 ± 4.5 minutes), all surgeries were uneventful. Rebubbling was required in 1 eye (16.6%). Best spectacle-corrected visual acuity improved significantly in all eyes. There was no primary graft failure. CONCLUSIONS:This technique (double bubble technique) enables safe and easy DMEK surgery, even in eyes that have been previously vitrectomized and IOL-sutured. Further clinical studies with a large number of patients exhibiting complex eyes are required to definitively establish the clinical value of this technique.