Reverse big bubble: a new technique for preparing donor tissue of Descemet membrane endothelial keratoplasty

Recently, endothelial keratoplasty has been shown to offer a promising alternative to penetrating keratoplasty for the management of corneal endothelial failure. Melles et al 1 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. 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 …