All DMEK procedures were performed by the same experienced surgeon (TH), as previously described in literature37 (link),38 (link). Briefly, a pre-stripped donor tissue was punched for the estimated size (approximately 8.0-mm) with asymmetric semicircular marks on a vacuum punch (Moria Japan, Tokyo, Japan) stained with 0.1% Brilliant Blue G dye37 (link),38 (link). After removing the host’s Descemet membrane under air infusion, a DMEK graft was implanted using an IOL inserter (WJ-60M; Santen, Osaka, Japan) into the anterior chamber via a 2.8-mm-corneoscleral tunnel; it was then unfolded, and fixed with 20% SF6 gas. Peripheral iridectomy was performed at the 6 o’ clock position using a 25-gauge vitreous cutter (Stellaris PC Vitrectomy system; Bausch & Lomb, St. Louis, MO, USA).
At the end of the surgery, a subconjunctival injection of 0.4 mg of betamethasone (Rinderon; Shionogi, Osaka, Japan) was administered. Two hours after surgery, slit-lamp examination was performed. All patients were instructed to maintain the supine position for several days. Postoperative medications included a combination of 1.5% levofloxacin (Cravit; Santen), betamethasone (Sanbetason; Santen), and 2% rebamipide ophthalmic solution (Mucosta; Otsuka, Tokyo, Japan), four times daily for 3 months; the dosage was tapered thereafter. Topical tropicamide was not included in the postoperative regimen.
At the end of the surgery, a subconjunctival injection of 0.4 mg of betamethasone (Rinderon; Shionogi, Osaka, Japan) was administered. Two hours after surgery, slit-lamp examination was performed. All patients were instructed to maintain the supine position for several days. Postoperative medications included a combination of 1.5% levofloxacin (Cravit; Santen), betamethasone (Sanbetason; Santen), and 2% rebamipide ophthalmic solution (Mucosta; Otsuka, Tokyo, Japan), four times daily for 3 months; the dosage was tapered thereafter. Topical tropicamide was not included in the postoperative regimen.
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