Modified Descemet’s Stripping Automated Endothelial Keratoplasty: The Use of Ophthalmic Viscoelastic Devices in Hypotonic Eyes That Had Undergone Glaucoma Filtering Surgeries

Figure 1

Photographs showing the modified DSAEK surgical technique using OVDs. (a) After securing the wound with interrupted 10-0 Nylon sutures, air was injected under the graft to fill the anterior chamber as much as possible. Injection was stopped when air began to migrate from the sclera flap into the bleb space (black star). (b) Then we penetrated the conjunctiva apart from the bleb by inserting a 30 G needle into the bleb and injecting Healon V. (c) Healon V was injected into the bleb until the encapsulated space was completely filled and the shape of the air bubble in the anterior chamber (AC) became deformed (arrows). (d) The DSAEK graft became firmly attached due to the pressure of the injected air, which also facilitated the draining of the remaining interface fluid. After 15 min, we confirmed that adequately high IOP was maintained by the air bubble in the AC (white star).

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