New forceps free injection technique for delivering descemet membrane endothelial keratoplasty preloaded endothelium-in grafts

Purpose: To describe a new method for delivering DMEK grafts into the recipient's eye with endothelium inward configuration using a no-forceps injection technique Methods: We retrospectively review 11 patients that underwent DMEK surgery at our institution using a no-forceps injection technique. The graft was preloaded into an intraocular lens (IOL) cartridge and connected to an anterior chamber maintainer (ACM). A 5 ml non luer lock syringe was inserted into the other end of the ACM to create a one-flow system. The cartridge was inserted into the posterior end of an injector, and the graft was successfully delivered into the recipient's eye. Result: Twelve eyes of 11 patients were included. Mean follow-up was 9.16 +/- 1.3 months. At baseline, mean best corrected visual acuity (BCVA) was 0.76 +/- 0.13 logMAr and mean endothelial cell density (ECD) was 2619.00 +/- 115.89 cells/mm(2). At follow-up, BCVA significantly improved to 0.22 +/- 0.05 logMAR (p= 0.003). Although we observed a significant reduction in ECD at follow-up (1688 +/- 182.20, p=0.002), our patients lost only 35.69 +/- 6.36% of endothelial cells. Conclusion: Our technique can help surgeons safely deliver an endothelium-in graft into the recipient's eye. The method doesn't require the use of a forceps, minimizing the risk of endothelial cell loss or graft damage.