Endothelial Keratoplasty With Silicon Oil And Anterior Chamber Intraocular Lens In Situ- Modified Technique With Continuous Positive Pressure Air Pump

To describe a modified surgical technique using a positive pressure air pump to facilitate graft adherence during Descemet stripping automated endothelial keratoplasty (DSAEK) in complex anterior segment anatomy. Achieving adequate air tamponade and graft adherence remains challenging in eyes with altered anatomy such as aphakia, vitrectomized eyes, prior trabeculectomy, or glaucoma drainage devices. This report highlights the use of controlled positive pressure air infusion to enhance lenticule adherence in a vitrectomized, silicone oil filled eye with a prior trabeculectomy and an anterior chamber intraocular lens in situ.

Tertiary care centre  : Dr Rajendra Prasad centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi

Department of Cornea, Cataract and Refractive services

A male patient in his twenties presented with phthisis bulbi in the right eye and pseudophakic corneal decompensation in the left eye. The left eye had a complex surgical history including prior vitrectomy, trabeculectomy, presence of an anterior chamber intraocular lens (ACIOL), and silicone oil in situ. Descemet stripping automated endothelial keratoplasty (DSAEK) was planned while retaining the silicone oil, as its removal was contraindicated.

Continuous positive air pump assisted DSAEK was performed. The use of controlled positive pressure air tamponade helped maintain a stable anterior chamber, prevented hypotony, limited migration of silicone oil into the anterior chamber, and facilitated complete graft adherence. Excessive air tamponade was avoided by monitoring graft attachment in real time using intraoperative optical coherence tomography.

Postoperatively, the patient achieved an uncorrected distance visual acuity of 20/120 with a well attached and functioning DSAEK lenticule measuring 90 µm in thickness. Air pump assisted DSAEK may therefore provide favorable anatomical and visual outcomes in complex eyes with silicone oil in situ, helping overcome the challenges associated with oil filled eyes undergoing endothelial keratoplasty.

The use of air pump assisted DSAEK avoids anterior chamber fluctuations and helps prevent silicon oil migration into anterior chamber.Maintaining air tamponade at a set intraocular pressure helps promote complete graft-host adhesion without unnecessary IOP spikes.

Our technique helped achieve successful anatomical and visual outcomes, indicating that it can be used in eyes with complex anatomy like silicon oil in situ in addition to post glaucoma drainage devices or trabeculectomy, aphakic, vitrectomised eyes.