Wound-assisted air injection in Descemet Stripping Automated Endothelial Keratoplasty

Background:Early postoperative graft detachment remains one of the most common complications of DSAEK.Objectives:To describe a modification of a simple method to facilitate a firm AC, without a leak, during DSAEK.Method:Ten consecutive DSAEK surgeries were reviewed. Surgery was performed by a single surgeon (HA). At the beginning of surgery, a trapezoid paracentesis was made at the limbus using a 20G MVR blade. The trapezoid incision was made by inserting the blade halfway, creating a cut with an internal opening half the width of its external opening. After inserting the corneal disc and suturing the main incision, air was injected with a 25G tapered hydrodelineation cannula. The tip was engaged at the trapezoid paracentesis and did not enter the anterior chamber. A firm, full air bubble was formed in the anterior chamber, and no leaking occurred at the paracentesis site, which acted as a one-way valve.Results:All grafts were adhered from the first day after surgery, and no dislocations were observed. All corneas were clear at the one-month postoperative visit.Conclusions:Wound-assisted air injection is a safe, effective, simple method for achieving a firm air bubble during DSAEK, potentially reducing dislocation rates.