EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/511377
39 EW CORNEA May 2015 For one of the last steps, instead of using just room air to support the graft, he advised practitioners put in 20% SF6 (sulfur hexafluoride). "It lasts longer in the front of the eye so there are more days of support for the graft," Dr. Straiko said. "It gives those slow-to-wakeup grafts a little extra time, so that they don't just fall off." Outcomes with the approach have been promising. "My person- al rebubble rate is between 3 and 4% now—rebubble rates used to be around 20%," Dr. Straiko said. He also has not had a primary graft failure in more than a year with this standardized DMEK tech- nique. Undertaking the approach For those who have not tried DMEK, Dr. Straiko cautioned that it is a completely different skill set than Descemet's stripping automated endothelial keratoplasty (DSAEK). In fact, it can actually work against those versed at DSAEK who think they are going to apply the same skills to DMEK. "You have to come at it with the attitude that it's a com- pletely new surgery and not just a new iteration of DSAEK," he said. Before undertaking DMEK initially, he encourages practitioners to watch online videos, find a mentor, and perhaps take a class so that they can learn and see the steps firsthand. atch how Dr. Straiko performs the technique at youtu.be/ J85evznXNSk and find additional tips and tricks at www.youtube.com/ user/DeversLASIKCorneaCat. Still, Dr. Straiko is convinced that this is a technique any skilled cornea surgeon can perform. "It just takes practice and [an] understand- ing [of] the technique," he said. As for the new standardized approach, no changes have been made for about a year. "I think that speaks well of the technique—we're at a steady point," he said. "For a while it seemed like I was changing some- thing every week." Even with standardized DMEK's broadened appeal, DSAEK continues to have a place, too, Dr. Straiko said. "Don't throw away your DSAEK tools because there are still com- plicated eyes that have had a lot of prior glaucoma surgery or that don't have a stable lens/iris diaphragms," he said. "Those cases are still best served with DSAEK." EW Editors' note: Dr. Straiko has no fina - cial interests related to this article. Contact information Straiko: Mike.straiko@gmail.com DISCOVER WHO, WHAT, WHERE, AND WHEN. e y e o p e n e r . a c c u t o m e . c o m FIND WHAT YOU'VE BEEN LOOKING FOR. SEE WHAT YOU'VE BEEN MISSING.