To Open:

• Try tapping perpendicularly to the end of the scroll. Sending fluid waves into scroll to open it.
• Tap vertically and centrally, aligned with the long axis of the scroll. Skew your tapping to the more open or more peripheral end.
• If the scroll is tight, consider using a cannula/BSS to “flip open” one edge. Alternatively, a Fogla cannula (opening on sides) can be inserted into scroll and BSS used to push the graft open.

Most likely next conformation(s):

• Simple Fold (most likely)
• Bouquet
• Double Scroll

To Open:

• Use a two cannula Dirisamer technique.
• The Red Cannula is stationary and mildly compressing the cornea.
• The Green Cannula is dynamic. Tap just to the open side of (not on top of) the folded edge. You can direct your taps slightly toward the fold.
• Continue to advance your dynamic cannula (Green) until the graft has opened completely, taking breaks to recenter as needed.
• No alternative option here as this “always” works.

Most likely next conformation(s):

• Edge Fold

To Flip:

• Note the confirmation of the graft (backwards S).
• Inject small and sequential bursts of BSS along the iris plane.
• Use the BSS to “push” the folded edge around and thus roll the graft over.
• If a shallow AC is maintained, the graft will remain unscrolled.

Most likely next conformation(s):

1. Scroll
2. Simple Fold

To Open:

• Tap directly down on the center of the graft along the long axis.

Most likely next conformation(s):

1. Simple Fold (most likely)
2. Bouquet (if eccentric tapping)

To Open:

• Tap directly down on the center of the graft along the long axis. Skew tapping toward the more open end, treating it as if it were a double scroll.
• Tap at open end, perpendicular to long axis and march taps centrally as graft opens. This maneuver takes advantage of the asymmetry of this conformation.

Most likely next conformation(s):

1. Simple/edge Fold(s)

To Open:

• Slowly indent the cornea peripheral to the edge fold and then quickly release. This will “pull” the edge open.
• Use a Dirisamer technique or simple tapping (without static/red cannula) to open the fold.
• Burp aqueous from an existing wound (ideally a para) to “pull” the edge open. This may require rotating the graft (sweep the cornea along edge of graft in a path that is tangential to the limbus).
• If the fold is very small and the graft is centered, just go ahead and place a moderate size gas bubble.

Most likely next conformation(s):

1. Done!

To Resolve:

• Deepen the anterior chamber with BSS through a para, using the BSS current and space created to help re-orient the graft.
• Tap along apex or inside of the fold and it should straighten out into a scroll (deep chamber required).

Most likely next conformation(s):

1. Scroll

It Depends:

• Smaller side on the top (40/60)
  • This is a (slightly more difficult) Simple Fold
  • Open with Dirisamer (see Simple Fold)
• Smaller Side on bottom (60/40)
  • This graft is Inverted.
  • Jet BSS along iris surface (see Inverted) to roll the graft over.
• 50/50 Taco
  • No way to open a 50/50 with tapping.
  • Jet BSS along iris surface (see Inverted) to roll the graft over.

Most likely next conformation(s):

1. Simple Fold
2. Scroll (if deepen AC with BSS)
3. Origami