The most common reason cited for the slow adoption of Descemet’s membrane endothelial keratoplasty, particularly in the United States, is the perceived difficulty of the surgery and, specifically, the intraoperative challenges associated with graft unfolding.
This is a somewhat strange but extremely persistent objection. Despite the fact that the whole operation can be performed inside of 30 minutes (and the graft unfolding component in 5 minutes), with no special equipment, by a single unassisted surgeon, free of any awkward or dangerous maneuvers, and usually with only a few
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