Use of Accidentally Torn Descemet Membrane to Successfully Complete Descemet Membrane Endothelial Keratoplasty

Purpose:To describe the use of an accidentally torn Descemet membrane (DM) to successfully complete Descemet membrane endothelial keratoplasty (DMEK) surgery.Methods:Retrospective, observational case series of 3 eyes of 3 patients undergoing DMEK with a DM accidentally torn into 2 pieces during graft preparation. The mean outcome measures included best-corrected visual acuity, endothelial cell density, and central corneal thickness, before and at 1, 3, and 6 months after the DMEK surgery was performed.Results:During graft preparation, immediately before transplantation, a large tear within the 8.0-mm marking line of the DM occurred, resulting in a DM torn into 2 pieces. In all the eyes, both pieces were successfully implanted into the anterior chamber, unfolded and attached to the posterior corneal stroma, one after the other. Six months after the surgery was performed, the best-corrected visual acuity ranged between 20/30 and 20/25. Endothelial cell loss was about 30% (range 28%-32%) 6 months after the surgery. Pachymetry findings showed normal corneal thickness 6 months after the surgery. All corneas remained clear without any signs of graft failure within 6 months of follow-up.Conclusions:DMEK surgery can be successfully completed despite the accidental tearing of donor DMs during the preparation of DMEK grafts by the sequential implantation of both DM pieces