Surrogate scleral rim with fibrin glue: a novel technique to expand the pool of donor tissues for Descemet stripping automated endothelial keratoplasty

Abstract

Descemet stripping automated endothelial keratoplasty is being performed in increasing number of cases each year. An adequate scleral rim on all sides is mandatory for the donor cornea to be mounted on the artificial anterior chamber for microkeratome-assisted dissection. Occasionally, the scleral rim may however be inadequate. The primary cause of inadequate scleral rim is poorly trained technicians in in-situ excision technique. Hence, we devised a novel technique for performing successful microkeratome-assisted dissection in donor corneas with inadequate scleral rim. A surrogate scleral rim was obtained from the donor tissue not fit for optical keratoplasty. It was then glued to the optical grade donor cornea that had an inadequate scleral rim either focally or circumferentially. The combination was then used for a successful microkeratome-assisted dissection followed by endothelial keratoplasty.