Viscoleastic Tamponade Applied to the Ocular Surface for Enhanced Control of Gaseous Egress From the Anterior Chamber During Final Bubble Titration in DMEK Surgery: The "Polite" Burp.

Purpose: To present a novel technique for enhancing the surgeon's control over the volume of air or gas that is "burped" from the anterior chamber during final bubble and intraocular pressure (IOP) titration in Descemet membrane endothelial keratoplasty. Methods: After ascertaining that the intracameral bubble is either too large and/or has rendered IOP too high, a bead of ophthalmic viscoelastic is applied to the ocular surface over a paracentesis incision, which is then depressed in the usual fashion to burp gas from the anterior chamber. Results: The weight and viscosity of the viscoelastic create a tamponade that slows the egress of gas from the anterior chamber, thereby making it more controllable. Conclusions: If the bubble size or IOP needs to be reduced at the conclusion of the Descemet membrane endothelial keratoplasty procedure, application of ophthalmic viscoelastic over the paracentesis can enhance the surgeon's control over the volume of gas burped from the anterior chamber, thereby reducing the tendency to swing between a bubble that is too large or too small.