A Novel Marking Technique for Descemet Membrane Endothelial Graft Using an Ophthalmic Viscoelastic Device

To describe the viscoelastic marking technique, a novel marking technique of Descemet membrane endothelial keratoplasty (DMEK) grafts that enables usage of a single donor cornea for 2 surgeries-one that uses Descemet membrane and endothelium (DMEK) and the other using the stroma and Bowman layer.A retrospective case analysis was performed on 26 eyes of 26 consecutive patients who underwent DMEK using the "viscoelastic marking technique." In this novel technique, an ophthalmic viscoelastic device (Healon 5) is placed over the endothelial side. Descemet membrane is then folded in half over the ophthalmic viscoelastic device with the stromal side up, and the F mark is drawn on the stromal side of the folded Descemet membrane. Primary outcome was best spectacle-corrected visual acuity, and secondary outcomes included graft detachment and rebubble rate, graft failure, and endothelial cell density.Mean best spectacle-corrected visual acuity improved significantly from 1.0 ± 0.7 logarithm of the minimum angle of resolution (LogMAR) before the surgery to 0.9 ± 0.7 LogMAR, 0.5 ± 0.6 LogMAR, 0.4 ± 0.2 LogMAR, and 0.4 ± 0.4 LogMAR at 1, 3, 6, and 12 months after surgery, respectively. Seven eyes (27%) had partial graft detachment that required air injection. Primary failure occurred in 3 eyes (11%). There were no free-floating donors or recognized inverted donors. The endothelial cell density loss at 12 months after surgery was a cell-loss rate of 38.3%.The viscoelastic marking technique is a simple, approachable, and safe technique for marking DMEK grafts while preserving the anterior cornea for additional surgery.