Endoilluminator–assisted descemet membrane endothelial keratoplasty (E-DMEK) for enhanced trans-corneal illumination in eyes with chronic pseudophakic bullous keratopathy (PBK)

Descemet membrane endothelial keratoplasty (DMEK) is the most desirable corneal transplant surgery as it is associated with the least chances of failure due to endothelial rejection and has the fastest visual recovery among corneal transplants. This technically challenging surgery involves several critical steps such as graft unfolding, positioning and correct orientation. Severe pre-existing corneal oedema limits visibility and prolongs the surgical duration, adversely affecting the success. We present two cases of severe corneal oedema, poor anterior chamber visualisation, wherein we performed endoilluminator-assisted DMEK (E-DMEK). This helped in intraoperative visualisation, reduced the surgical time and reduced graft manipulation. Postoperatively, both patients showed significant improvement in visual acuity (from counting fingers to 20/80 and 20/30) and reduced corneal thickness (556 and 484 microns) at 6 months. The endoilluminator is a practical and cost-effective modification that improves surgical outcomes for both experienced and novice surgeons, expanding the indications for DMEK and ensuring successful postoperative results.