Paracentesis as valve re-bubbling technique for Descemet’s membrane endothelial keratoplasty (DMEK) graft detachment

Introduction We present a variation in the slit-lamp microscope re-bubbling technique for DMEK detachment in which a paracentesis is used as a self-sealing valve. Methods Of twenty-eight consecutive DMEK cases, five (18%) required re-bubbling. A 20-gauge side port blade was used to make a paracentesis in the inferior temporal quadrant. A 30-gauge cannula mounted on a 3 ml syringe was employed to inject air using the paracentesis as a valve allowing better control over intraocular pressure and percentage anterior chamber air fill. Results Graft re-attachment was achieved in all cases. One case required two re-bubbling procedures. There were no cases of pupil block glaucoma or other complications. Conclusion Slit-lamp re-bubbling is a practical and safe alternative to taking patients back to the operating room. Using a new paracentesis for valve action control over air injection with a blunt cannula adds better control and may help to reduce complications.