BrightMEM Surgical Pearls

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BrightMEMTM Anterior Keratoplasty
Pearls for Success
1) Case selection
- The ideal patient for BrightMEM anterior keratoplasty has 25-75% limbal stem cell deficiency,
with or without an epithelial defect. Non-healing corneal defects (post-herpetic, post-surgical,
atopic, etc.) are also very appropriate. For a surgeon’s first few cases, avoid choosing
patients with severe ocular surface problems, particularly in cases with active inflammation,
stromal edema, uncontrolled IOP or insufficient fornix depth to allow bandage contact lens
fitting.
2) BrightMEM Allograft prep
- Warm the tissue for an hour before trephination to prevent premature separation from
stroma.
- Using an operating microscope, check that the allograft is 100% flat and not partially
folded. If there is a small fold, first try a few drops of BSS to float the edge free or use a
nontoothed (tying) forceps to unfold it.
- When removing the tissue from the chamber, grasp the tissue by the scleral rim on the hinge
side, closest to where the S-stamp is. Gravity helps keep the graft flat as you lift it out of the
Optisol while transferring to the Teflon block. Once on the Teflon block of the vacuum
trephine, if the graft appears wrinkled or partially scrolled, add a few drops of Optisol to the
well. Hold the graft by the scleral rim closest to where the S-stamp is and gently wick out fluid
by dabbing the scleral rim inferiorly, allowing the graft to lay back down in place.
3) BrightMEM Allograft trephination
- Descemet’s membrane has been peeled from stroma up to the shaded hinged area and the Sstamp
is located close to the hinge as shown here:
- If you are trephining a larger graft (>8.5mm), you may sometimes need to punch slightly
eccentrically to keep the S-stamp close to the edge, so that you don’t punch into the area where
hinge is. (if you punch into the hinge, the graft may not detach from the stromal button cleanly).
- Smaller grafts (7.5 or 8mm) may be preferable to ensure you do not trephine into the hinge area.
In addition, because we are still learning whether the corneal nerves penetrate BrightMEM,