Descemet's Stripping Without Endothelial Keratoplasty

Daniel Garcerant; Nino Hirnschall; Nicholas Toalster; Meidong Zhu; Li Wen; Gregory Moloney

Disclosures

Curr Opin Ophthalmol. 2019;30(4):275-285. 

In This Article

Current Surgical Technique

The combination of the 'optical zone' and 'stripping over scoring' hypotheses has led to the following surgical technique.

Preoperative preparation includes marking the cornea at the center of the pupil (prior to peribulbar block) in mesopic conditions to guide centration. The pupil is then dilated to allow for a better red reflex during descemetorhexis.

In the operating theatre a caliper is used to create 4-mm diameter imprint centered on the previous mark to delimitate the descemetorhexis. A single main 2 mm clear corneal incision is created and the anterior chamber is filled with cohesive viscoelastic. A reverse Sinskey hook is positioned in the endothelial edge of the 4-mm circle, then with very gentle pressure over the endothelium, small side to side movements create a small Descemet's membrane tag. The tag is thereupon picked with grasping forceps and a Descemet's tear is propagated in a circle. Often this will fragment requiring a new tag to be created, this must be done so with minimal stromal trauma. An effort to maintain Descemetorhexis along the 4 mm mark without leaving any portion inside is recommended. Viscoelastic is then removed with irrigation/aspiration and main wound is hydrated.

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