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Case Reports in Ophthalmological Medicine
Volume 2018, Article ID 9387810, 5 pages
Case Report

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

1Department of Ophthalmology, Heart Life Hospital, Okinawa, Japan
2Department of Ophthalmology, Ryukyu University, Okinawa, Japan
3Department of Ophthalmology, Yokohama Minami Kyosai Hospital, Kanagawa, Japan
4Department of Ophthalmology, Saitama Medical University, Saitama, Japan

Correspondence should be addressed to Itaru Oyakawa; pj.oc.oohay@awakayourati

Received 27 November 2017; Accepted 10 January 2018; Published 1 February 2018

Academic Editor: Antonio Ferreras

Copyright © 2018 Itaru Oyakawa et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Purpose. Descemet’s stripping automated endothelial keratoplasty (DSAEK) is more difficult in hypotonic eyes with filtering bleb, due to the difficulties in elevating the intraocular pressure (IOP). We report a new method that uses ophthalmic viscoelastic devices (OVDs) to achieve good graft adhesion. Case Presentation. We performed modified DSAEK surgery on 2 eyes of 2 patients, who had previously undergone a trabeculectomy. Both eyes had functioning filtering blebs; the IOP was lower than 10 mmHg without medication. After the graft was inserted into the anterior chamber, the conjunctiva was penetrated, apart from the bleb, using a 30 G needle, and Healon V® was injected into the bleb until the encapsulated space was filled completely. Air was subsequently injected into the anterior chamber to promote the graft attachment to the back surface of the cornea. The IOP was elevated above 40 mmHg in both eyes 1 h after surgery and then decreased to less than 30 mmHg over the subsequent 3 h period. The implanted graft showed good adhesion and no dislocation. Conclusions. Our novel DSAEK procedure that adds one step of OVD injection into the filtering bleb may be useful for hypotonic eyes that had undergone filtering surgeries.