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Reverse big bubble: a new technique for preparing donor tissue of Descemet membrane endothelial keratoplasty
  1. S Zarei-Ghanavati,
  2. H Khakshoor,
  3. M Zarei-Ghanavati
  1. Mashhad University of Medical Sciences, Mashhad, Iran
  1. Correspondence to Dr Siamak Zarei-Ghanavati, Department of Ophthalmology, Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences (MUMS) Eye Research Center, Abootaleb Boulevard, Mashhad, 91959-65919, Iran; sizagh{at}, zareis{at}

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Recently, endothelial keratoplasty has been shown to offer a promising alternative to penetrating keratoplasty for the management of corneal endothelial failure. Melles et al1 introduced a new technique for transplantation of Descemet membrane (DM) through a self-sealing incision, which they referred to as Descemet membrane endothelial keratoplasty (DMEK). They obtained donor material by stripping DM with fine forceps. This is a challenging and time-consuming procedure with inevitable endothelial cell loss and possibility of DM tear. Herein, we describe a new technique to prepare donor tissue for DMEK, the reverse big-bubble technique.

Surgical technique

A corneoscleral button was placed endothelial side up on a donor Barron punch and fixed by grasping the outer scleral edge. The endothelial layer was stained with trypan blue. A 27-gauge bevel-up needle attached …

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  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.