{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T16:40:10Z","timestamp":1751301610175,"version":"3.41.0"},"reference-count":4,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>Purpose:<\/jats:title>\n            <jats:p>To describe the preoperative planning, intraoperative surgical techniques, and postoperative outcomes of Descemet membrane endothelial keratoplasty (DMEK) in an eye with extreme axial myopia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>A 71-year-old female patient with severe 4+ nuclear sclerotic cataract and Fuchs dystrophy in the right eye presented with best-corrected visual acuity of counting fingers. Central corneal thickness was 605 \u03bcm, and optical biometry-based axial length was 33 mm. The DMEK graft was preloaded as a 7.5-mm diameter scroll in a micro Jones tube, injected into the anterior chamber, and opened without complication.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Intraoperatively, the anterior chamber deepened and shallowed extensively, consistent with zonular laxity. Despite a large volume of SF<jats:sub>6<\/jats:sub>, exotropia resulted in nasal displacement of the bubble and delayed attachment of the inferotemporal graft. Two subsequent 200-\u03bcL air bubbles were placed in clinic with the inferotemporal graft attaching after the patient laterally positioned on her nonoperative side. After 1 month, visual acuity improved to 20\/500, limited by myopic degeneration, and central corneal thickness to 525 \u03bcm. By 6 weeks, the graft was fully attached and the cornea clear.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>DMEK is feasible in eyes with extreme axial length but presents distinct challenges such as zonular laxity and exotropia. This case underscores the importance of individualized surgical planning and positioning in achieving successful outcomes in highly myopic eyes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/ebct.0000000000000041","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T16:00:06Z","timestamp":1751299206000},"page":"e0041","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Descemet Membrane Endothelial Keratoplasty in an Eye With 33-mm Axial Length"],"prefix":"10.1097","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7957-4928","authenticated-orcid":false,"given":"Anshuman","family":"Agrawal","sequence":"first","affiliation":[{"name":"Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanne C.","family":"Choi","sequence":"additional","affiliation":[{"name":"Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia","family":"Dryjski","sequence":"additional","affiliation":[{"name":"Chesapeake Eye Care and Laser Center, Annapolis, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derick O.","family":"Ansah","sequence":"additional","affiliation":[{"name":"Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Wang","sequence":"additional","affiliation":[{"name":"Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2798-038X","authenticated-orcid":false,"given":"Allen O.","family":"Eghrari","sequence":"additional","affiliation":[{"name":"Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD"},{"name":"Dana Center for Preventive Ophthalmology, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,6]]},"reference":[{"key":"R1-20250630","doi-asserted-by":"crossref","first-page":"1403","DOI":"10.1097\/ICO.0000000000003446","article-title":"Descemet membrane endothelial keratoplasty: 10-year cell loss and failure rate compared with Descemet stripping endothelial keratoplasty and penetrating keratoplasty","volume":"43","author":"Price","year":"2024","journal-title":"Cornea"},{"key":"R2-20250630","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/ICO.0000000000002203","article-title":"Learning Descemet membrane endothelial keratoplasty: a survey of U.S. corneal surgeons","volume":"39","author":"Koo","year":"2020","journal-title":"Cornea"},{"key":"R3-20250630","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.aopr.2024.06.003","article-title":"Complications of high myopia: an update from clinical manifestations to underlying mechanisms","volume":"4","author":"Du","year":"2024","journal-title":"Adv Ophthalmol Pract Res"},{"key":"R4-20250630","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1097\/ICO.0000000000002648","article-title":"Techniques, outcomes, and complications of preloaded, trifolded Descemet membrane endothelial keratoplasty using the DMEK EndoGlide","volume":"40","author":"Ighani","year":"2021","journal-title":"Cornea"}],"container-title":["Eye Banking and Corneal Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/ebct.0000000000000041","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T16:00:08Z","timestamp":1751299208000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/ebct.0000000000000041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":4,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/ebct.0000000000000041","relation":{},"ISSN":["2833-7018"],"issn-type":[{"value":"2833-7018","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]},"assertion":[{"value":"2025-04-10","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-19","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}