Donor disc attachment assessment with intraoperative spectral optical coherence tomography during descemet stripping automated endothelial keratoplasty
A 72-year-old female patient with corneal edema due to Fuchs corneal dystrophy, after 2 years, uneventful phacoemulsification surgery with intraocular lens implantation was scheduled for DSAEK. The visual acuity was 20/200. The following eye had visual acuity of 20/25 (correction + 1,0 Dsph) and underwent Descemet's stripping endothelial keratoplasty (DSEK) combined with phacoemulsification surgery 3 years earlier. Spectral-domain optical coherence tomography (SD OCT) examination revealed corneal edema with Descemet membrane folds on posterior corneal surface and fluid spaces under the corneal epithelium. Central corneal thickness was 843 μm.\nThe DSAEK procedure was performed under local, peribulbar anesthesia with additional intravenous sedation. The donor cornea was dissected with a Moria microkeratome (350 μm keratome plate). After fashioning the clear corneal incision, the Descemet membrane was stripped with reverse Sinskey hook. The surgery was discontinued and the optical coherence tomography (OCT) exam with commercially available SD OCT device (IVue; Optovue, Fremont; USA) was performed. The OCT device was held by the surgeon. Acquiring of the image was gained by pressing the foot pedal after focusing the anterior eye segment structures within the OCT scan []. After making sure that all of Descemet membrane was removed, the donor disc was inserted into the anterior chamber with Busin glide spatula. The corneal incisions were sutured with 10-0 nylon. The air was injected into the anterior chamber with following eye surface sweeping in order to remove fluid from the graft interface. The graft seemed to be attached when analyzing in the surgical microscope. After performing SD OCT, multiple fluid micro-spaces were revealed in the area of the graft interface []. Due to that, we performed corneal stab incisions in the four main clock hours. After incisions, SD OCT revealed a proper graft adhesion to the posterior corneal surface []. At the end of the surgery, the anterior chamber was left filled with quarter of the volume of injected air. The whole procedure lasted for 35 min, which increased the time of the surgery by approximately 15 min.