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Wound-assisted air injection in Descemet's stripping automated endothelial keratoplasty (DSAEK)

Poster Details

First Author: M.Gharra ISRAEL

Co Author(s):    A. Achiron   H. Avizemer                 

Abstract Details

Purpose:

To describe a simple method to create a firm air bubble facilitating graft adherence during DSAEK.

Setting:

Department of Ophthalmology, Wolfson Medical Center, Holon, affiliated to the Tel-Aviv University, Israel

Methods:

A trapezoid paracentesis was made at the beginning of the surgery at the limbus, using a 20G MVR blade, making the internal opening half the width of the external opening. After insertion of the corneal disc and suturing the main incision, air was injected with a 25G tapered hydrodelineation cannula, engaging the tip at the trapezoid paracentesis, not entering the anterior chamber. A firm full air bubble was formed in the anterior chamber without leaking from the paracentesis site, which acts as a one way valve.

Results:

10 consecutive cases, including 8 females with mean age of 78.5±11.1 years were reviewed retrospectively. Surgery was performed by a single surgeon (HA) due to pseudophakic bullous keratopathy (6 cases) prior DSAEK graft failure (3 cases) and Fuchs endothelial dystrophy (one case). All grafts were adhered since the first day after surgery, and no dislocations were observed. One patient had transient elevated intraocular pressure which resolved with anterior chamber paracentesis. All were clear at the one month post-operative visit.

Conclusions:

Wound assisted air injection is a safe and effective simple method to achieve a firm air bubble during DSAEK, with the potential to reduce or eliminate the need for rebubbling procedures, even in vitrectomized eyes. It also has the potential to be used in Descemet membrane endothelial keratoplasty (DMEK) where the rate of graft dislocation is even higher.

Financial Disclosure:

NONE

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