Minimized Endothelial Cell Loss in DSAEK (Descemet’s Stripping Automated Endothelial Keratoplasty) Using A 30-G Needle Insertion Technique

Descemet’s stripping automated endothelial keratoplasty (DSAEK) is part of a surgical evolution in the series of endothelial surgical techniques beginning with deep posterior lamellar keratoplasty initially described by Melles et al. In all such operations, the diseased endothelium is replaced with endothelial grafts of various thicknesses. The latest and most challenging technique using the thinnest graft is known as Descemet’s membrane endothelial keratoplasty. Various techniques for insertion of the lenticule into the anterior chamber (AC) have been described in the literature. –5 Currently one of the most commonly used techniques is the Busin glide pull-through. Other techniques include a modified intraocular lens glide and folding techniques of various configurations. –5 The ultimate goal in all of these approaches has been to reduce trauma to the graft and to minimize manipulation of the graft tissue during insertion to maximize the postoperative endothelial cell density (ECD) and visual acuity. Herein we describe our DSAEK technique of direct insertion of the endothelial graft lenticule over a bed of cohesive viscoelastic by using a bent 30-G needle through a temporal 5.5-mm scleral tunnel performed in 15 consecutive patients and present our postoperative results.