Pre-Descemet’s endothelial keratoplasty in 15 steps
by Priya Narang Agarwal, Priya Amar Agarwal

Pre-Descemet’s Endothelial Keratoplasty (PDEK)

by Amar Agarwal
About Video

In this video illustrates in 15 steps of pre-Descemet’s endothelial keratoplasty. Step first introduced trocar anterior chamber maintainer (T-ACM) into the eye. Step two: connect the T-ACM to an air pump. This facilitates continuous air infusion into the eye and helps to perform the procedure with an anterior chamber (AC) that is always well formed. Step 3 two side-port incisions are made at superotemporal and superonasal position. Step 4, descemetorhexis is performed with a reverse Sinskey hook. Two Sinskey hooks are introduced from both the side-port incisions and the diseased DM is peeled and scrapped off the recipient bed. Step 5, a 2.8-mm clear corneal incision is made and the peeled DM-endothelium complex is removed. Step 6, iridectomy being performed with a vitrectomy probe. Step 7: pre-Descemet’s endothelial keratoplasty (PDEK) graft being loaded into the cartridge of the foldable intraocular lens (IOL). Step 8 is performed before the graft is injected so that the force of the air does not displace the graft and doing so also ensures that there is enough room for the graft to enter and .be properly placed into the AC. Step 9, pre-Descemet’s endothelial keratoplasty (PDEK) graft being injected into the anterior chamber. Step 10, the clear corneal incision is then sutured with a 10-0 nylon. Step 11, correct orientation of the graft is checked with an endoilluminator. Step 12, after placing the graft in correct orientation, the donor lenticule is centered and oriented with the rolls of the scroll facing upward using short burst of BSS. Step 13, air pump is switched on and the anterior chamber (AC) is filled with air to facilitate further adhesion of the graft to the endothelial surface. Step 14, the edges of the donor graft have a tendency to curl up and push itself away from the recipient corneal bed. These peripheral edges need to be totally unrolled or else it can lead to small peripheral separations that usually do not seal down on their own and need to be treated. A reverse Sinskey hook is used to unroll the peripheral edges of the donor graft. The entire process is done very gently taking care to minimize the endothelial touch. The graft is then centered. Step 15, all the corneal wounds are sutured to ensure tight closure of the globe to prevent any inadvertent air leak from the AC. The infusion is stopped and the T-ACM is removed.

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