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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article number100497
JournalAmerican Journal of Ophthalmology Case Reports
Volume15
DOIs
StatePublished - Sep 1 2019

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Descemet Stripping Endothelial Keratoplasty
Anatomy
Air
Transplants
Aniridia
Aphakia
Vitrectomy
Wounds and Injuries
Anterior Chamber
Iris
Needles

Keywords

  • DSAEK
  • DSEK
  • Endothelial keratoplasty
  • Sheets glide
  • Surgical technique

ASJC Scopus subject areas

  • Ophthalmology

Cite this

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title = "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.",
keywords = "DSAEK, DSEK, Endothelial keratoplasty, Sheets glide, Surgical technique",
author = "Ellen Koo",
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language = "English (US)",
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AB - 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.

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