Rotational alignment of corneal endothelial grafts and risk of graft detachment after Descemet membrane endothelial keratoplasty: a double‐masked pseudo‐randomized study

The posterior cornea is rotationally asymmetric, and Descemet membrane endothelial keratoplasty (DMEK) grafts preferentially scroll vertically. This prospective study assessed whether graft attachment after DMEK differed depending on the rotational alignment of the donor graft in the recipient eye. Pseudo‐randomization and blinding of the graft orientation in the recipient’s eye were possible by procedural separation. The eye bank recorded the position of an orientation marker in the donor cornea; the surgeon preparing the DMEK graft recorded an upside‐down marker relative to the eye bank marker; and the surgeon assessed the position of the upside‐down marker in the recipient after DMEK. Surgeons were masked towards the eye bank marker. Using mixed‐effects models, we assessed graft attachment relative to the rotational alignment of the donor graft...