{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,5,14]],"date-time":"2025-05-14T00:40:36Z","timestamp":1747183236795,"version":"3.40.5"},"reference-count":19,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T00:00:00Z","timestamp":1592956800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To evaluate the intraoperative use of ultrasound biomicroscopy (UBM) during Descemet's membrane endothelial keratoplasty (DMEK) to determine graft's orientation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Prospective interventional study of eight eyes of seven patients who underwent DMEK. Following the identification of correct graft orientation using 'Blue cannula tip' sign during DMEK surgery, UBM was used to ascertain graft's orientation. The rate of successful DMEK graft orientation determined by the UBM was registered and verified postoperatively by anterior segment\u2010optical coherence tomography (OCT). Intra\u2010 and postoperative complications, postoperative clearance of the cornea, corrected distance visual acuity and endothelial cell loss were also noted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included five males and two females aged 54\u201382\u00a0years with corneal oedema due to Pseudophakic bullous keratopathy (<jats:italic>n<\/jats:italic>\u00a0=\u00a05), Fuchs\u2019 endothelial dystrophy (<jats:italic>n<\/jats:italic>\u00a0=\u00a02). In all cases, the technique allowed proper determination of the graft's orientation. In one case, \u2018blue cannula tip\u2019 sign showed correct orientation while UBM identified an upside\u2013down graft. The graft was inverted in the anterior chamber using fluid jets, and repeat \u2018blue cannula tip\u2019 sign and UBM examination both showed correct orientation. In all cases, postoperative anterior segment\u2010OCT demonstrated correct graft orientation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Use of intraoperative UBM to determine graft orientation during DMEK correlated with proper graft orientation, as was verified postoperatively by anterior segment\u2010OCT. The use of UBM can be particularly helpful in cases of poor graft visibility due to opaque corneal stroma, pigment or blood in the anterior chamber during surgery, or when the blue tint of the graft fades rapidly, which may preclude proper determination of graft's orientation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aos.14515","type":"journal-article","created":{"date-parts":[[2020,6,24]],"date-time":"2020-06-24T10:03:26Z","timestamp":1592993006000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Real\u2010time intraoperative ultrasound biomicroscopy for determining graft orientation during Descemet's membrane endothelial keratoplasty"],"prefix":"10.1111","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0246-4787","authenticated-orcid":false,"given":"Yoav","family":"Nahum","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Rabin Medical Center Petach Tikva 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