New DMEK “Punch-Rescue” Technique: Saving High-Risk Grafts

The new “Punch-Rescue” technique:

Although the peripheral tear of the donor Descemet's membrane is a universal risk when preparing a fine lamellar endothelial keratoplasty (DMEK), this danger is much more pronounced with tissue from donors with diabetes or who have undergone prior surgery (such as cataract surgery) with corneal incisions. These tears often require an immediate conversion to thick lamellar endothelial keratoplasty (DSAEK) or result in total graft loss.

This video shows a new “rescue” technique developed by the Dr. Arthur Hammer. It is inexpensive, using a sterile skin biopsy punch to isolate and stop radial tears during graft preparation. By transforming a linear tear into a controlled circular edge, the surgeon can prevent radial extension and thus save the graft.

Why is this technique important?

• Mitigating a universal risk: It provides a safety net for all types of donor tissue, especially fragile or high-risk grafts.
• Reducing health costs: This simple and reproducible method uses low-cost sterile equipment, available in the majority of operating theatres. By avoiding the waste of grafts and valuable resources, it limits the additional costs for health systems that are already under pressure and optimizes the medico-economic efficiency of corneal transplantation.
• Expansion of the donor pool: It allows the safe use of fabrics that would otherwise be considered unsuitable for DMEK.
• Improving results: By minimizing tissue loss and reducing the need for surgical conversion, it allows more patients to benefit from the excellent visual results of DMEK.

This optimization of the donor pool is essential to meet growing global demand and to overcome the challenges inherent in intraoperative tissue preparation.