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Safety-Net Suture for Aphakic Descemet Membrane Endothelial Keratoplasty

2022; Lippincott Williams & Wilkins; Volume: 41; Issue: 6 Linguagem: Inglês

10.1097/ico.0000000000002923

1536-4798

Osvaldo Berger, Jaime Kriman, Alfonso Vasquez-Perez, Bruce Allan,

Intraocular Surgery and Lenses

The purpose of this research was to describe a low-cost, accessible method for reducing the risk of posterior donor dislocation in Descemet membrane endothelial keratoplasty (DMEK) performed in eyes with aphakia and a large iris defect (unicameral eyes)-the "safety-net suture."We review 3 cases of aphakic bullous keratopathy in unicameral eyes treated successfully using DMEK aided by a simple technique to create a temporary, partial barrier between the anterior and posterior chambers. The safety-net suture technique is based on a continuous 10-0 polypropylene suture placed across the anterior chamber in a cat's-cradle pattern anterior to the trabecular meshwork. At the end of surgery, after air tamponade of the DMEK donor, the 10-0 polypropylene suture is removed.All 3 cases were completed with no intraoperative posterior dislocation. A partial postoperative detachment in 1 case was successfully treated with repeat air tamponade. The corneas remain clear in early follow-up, 1 to 10 months after surgery.The safety-net suture is a simple, low-cost method of reducing the risk of intraoperative posterior dislocation for DMEK in unicameral, aphakic eyes.