Dr. SOHAM BASAK

Dr. SAMAR KUMAR BASAK

Abstract

Descemet stripping endothelial keratoplasty(DSEK) in aphakic bullous keratopathy(ABK) is challenging due to unicameral anatomy, large iris defects and prior vitrectomy. There is risk of posterior graft dislocation, difficult air tamponade and vitreous disturbance due to fluid turbulence. We describe a new air-assisted technique to overcome the challenges.

A 5mm sclero-corneal tunnel and two side-ports are made. After air injection, Descemet stripping is under air bubble to avoid use of viscoelastic and irrigation. Cohesive viscoelastic is coated around incision and DSEK lenticule is placed stromal-side-up over that. Push through technique with 30G needle is done. While pushing, graft is angled upwards along posterior host stroma so that it glides over the air bubble in AC. There is no further fluid use, minimal unfolding maneuvers, and small air injection gives good tamponade.

This video shows two examples of this technique in ABK with large iris defect and coloboma with microcornea.