Surgical Technique for DMEK

Currently there are no FDA-approved DMEK injectors. American surgeons have found many creative off-label methods around this obstacle. Many surgeons use modified intraocular lens injection cartridges for this purpose. The Staar microinjector (Staar Surgical Company, Monrovia, CA) was one of the most common inserters initially used for DMEK in the US (Fig. 131.1B). The Staar injector is an open system with a foam plunger and requires a viscoelastic agent to help deliver the tissue. This technique risks the introduction of viscoelastic into the anterior chamber during tissue injection, which can impede graft attachment. Another popular IOL cartridge based system is the Viscoject IOL injector (Bausch & Lomb, Aliso Viejo, CA) (Fig. 131.1A). The Price group reported improved rebubble rates when transitioning from the Staar injector with the use of viscoelastic to the Viscoject, which does not require viscoelastic and is a small closed-system inserter. A similar closed-system injector can be created with the AMO Emerald One Series IOL cartridge (Abbot Laboratories Inc., Abbot Park, IL), with a few key differences compared to other IOL cartridge injectors (Fig. 131.1D). Assembled with a standard Luer-Lok syringe filled with BSS and 14-French gauge nasogastric tubing, the Emerald One Series IOL cartridge is large enough that it can be used to aspirate the graft into the injector and small enough to be used through a 2.75 mm clear corneal incision. Similar to other injectors Key Concepts