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Chapter-28 Sutureless Descemet's Stripping Automated Endothelial Keratoplasty

BOOK TITLE: Corneal Transplantation

Author
1. Vajpayee Rasik B
2. Jhanji Vishal
3. Sharma Namrata
4. Beltz Jacqueline
ISBN
9788184488593
DOI
10.5005/jp/books/11167_28
Edition
2/e
Publishing Year
2010
Pages
6
Author Affiliations
1. RP Center of Ophthalmology, AIIMS, Ansari Nagar, New Delhi 110 029, India, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Centre for Eye Research, Australia, Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia, Centre of Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Center for Eye Research Australia, University of Melbourne, Melbourne, Australia, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, RP Center of Ophthalmic Sciences, AIIMS, Ansari Nagar, New Delhi, India, Cornea Services Royal Victorian Eye and Ear Hospital, Centre for Eye Research, University of Melbourne, Australia, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, University of Melbourne, Australia, All India Institute of Medical Sciences, RP Center, New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Centre for Eye Research Australia, University of Melbourne, Australia
2. Clinical Ophthalmology, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Dr RP Centre for Ophthalmic Sciences, AIIMS, New Delhi, Dr RP Center for Ophthalmic Sciences, AIIMS, New Delhi, The Chinese University of Hong Kong, 3/F Hong Kong Eye Hospital, 147K Argyle Street, Mongkok Kowloon, Hong Kong, The Chinese University of Hong Kong Hong Kong, The Chinese University of Hong Kong Hong KongShekhar, The Chinese University of Hong Kong, Hong Kong, Cornea Services Royal Victorian Eye and Ear Hospital, Melbourne, Australia
3. All India Institute of Medical sciences New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, RP Centre of Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences New Delhi, India, Dr Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, New Delhi, India, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, All India Institute of Medical Sciences, RP Center, New Delhi, India, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India, All India Institute of Medical Sciences (AIIMS), New Delhi, India, RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
4. Royal Victorian Eye and Ear Hospital, Melbourne, Australia, Royal Victorian Eye and Ear Hospital Melbourne, VIC Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia, Cornea Services Royal Victorian Eye and Ear Hospital, Melbourne, Australia, Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
Chapter keywords

Abstract

Descemet’s stripping automated endothelial keratoplasty is commonly being used as a preferred technique of corneal transplantation for corneal endothelial dysfunction. It obviates several weaknesses of the standard penetrating keratoplasty procedure that include prolonged visual recovery, induced astigmatism, risk of suture-related infections and long-term risk of wound rupture. We have made some useful modifications in the standard surgical technique of descemet’s stripping automated endothelial keratoplasty that are useful in the learning curve of the surgery. The creation of scleral tunnel as opposed to a clear corneal incision provides an optimal wound closure. The wound is self-sealing and does not require the application of any sutures thereby making it astigmatically neutral. Prevention of endothelial cell damage has been a key issue associated with DSAEK due to the earlier technique of folding of donor lenticule during insertion into the recipient’s anterior chamber. Advent of various inserting techniques using Busin’s glide or anterior chamber glide has been a major breakthrough in this direction. These techniques have eliminated steps of folding as well as excessive surgical maneuvers required to insert the donor tissue.

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