A modified surgical technique for Descemet's stripping automated endothelial keratoplasty (DSAEK) in altered or abnormal anatomy

Abstract

Purpose This paper describes a modified technique for the Descemet's Stripping Automated Endothelial Keratopasty (DSAEK) surgery in eyes with abnormal or altered anatomy. Certain anatomic abnormalities increase the level of surgical complexity, and lead to increased risk of donor lenticule detachment. These challenges include aniridia, abnormal iris, aphakia and hypotony from previous vitrectomy. Observations The Sheets glide was trimmed to 4mm in width and inserted into the clear-corneal wound. The “needle-push”/Fichman glide technique was used to insert the DSAEK donor graft. The modification of the technique involves maintaining the Sheets glide in the eye for the duration of the intraoperative air bubble. After confirming desired orientation of the graft, air was injected into the anterior chamber, creating a large air bubble between the graft and the Sheets glide. After 10 minutes, the Sheets glide was removed, and the main wound was closed. Conclusions and Importance This technique overcomes the challenges of posterior air bubble migration and posterior dislocation of the donor lenticule in eyes with altered anatomy.

Size and Shape Matter: Cell Viability of Preloaded Descemet Stripping Automated Endothelial Keratoplasty Grafts in Three Different Carriers

“…9,11 DSAEK surgery requires removal of the recipient Descemet membrane and insertion of donor tissue. Many techniques may be used for insertion of the donor DSAEK graft, [12][13][14][15][16][17][18][19][20][21][22] and various carriers/inserters have been developed with the intention of both protecting the donor graft from incision compression pressure and easing the insertion process. Glides (including the FDA-approved Busin glide and EndoGlide Ultrathin) require 2 incisions for use and a pullthrough technique, where the DSAEK graft is pulled from the inserter into the anterior chamber using delicate transchamber forceps, as well as an anterior chamber maintainer infusion line.…”

“Air-Assisted” Donor Lenticule Insertion in Descemet Stripping Endothelial Keratoplasty in Aphakia With Large Iris Defect and Without Posterior Capsular Support

“…Anterior segment abnormalities, such as aniridia, large iris defect, aphakia, and hypotony from previous vitreoretinal surgery, can pose challenges during surgery because donor lenticule adherence depends on the ability to maintain an air bubble in the AC for some time. [4][5][6] In aphakic eye without posterior capsular support, many surgeons prefer to implant a scleral-fixated intraocular lens (SFIOL) or posterior irisfixated IOL first and then perform DSAEK, as combined or staged procedures. [7][8][9][10] Secondary IOL implantation may not be suitable in certain aphakic individuals, such as monocular status, or have limited visual potential where the risks of placing an intraocular lens outweigh the benefits.…”

“…[1][2][3] Because Descemet membrane endothelial keratoplasty is more challenging, DSEK is mostly preferred in patients with corneal edema with complex or abnormal anterior chamber (AC) anatomy. 4 During DSEK surgery after donor insertion, air or isoexpansile gas is injected into the AC for tamponade that allows DSEK lenticule graft adhesion.…”