April 2006 1/3 My DSAEK/DSEK Surgical Technique by ... - Iogen

Preparation of Recipient
1. Temporal peritomy and use cautery as needed.
2. Make temporal scleral tunnel incision into the clear cornea.
3. Use cautery to ensure there is no bleeding in scleral tunnel.
4. Place stab incision to right of main incision (about 2mm into clear cornea in area that
will be covered by graft using #75 blade).
5. Insert a Moria chamber maintainer #19092 through peripheral cornea into anterior
chamber at 6:00 (left hand) for continuous infusion of anterior chamber during the
stripping and removal of Descemet’s membrane.
6. Use Moria Price hook #19091 to outline in Descemet’s membrane the portion to strip
away. The diameter should be slightly smaller than the size of the planned donor. Be
careful not to overly push up into stroma or to tear tissue as this can lead to
irregularities or loose pieces of stroma which can interfere with good apposition of
donor against recipient.
7. Inject VisionBlue® into the AC. This stains exposed areas of Descemet’s membrane
and allows better visualization of it. The darkest areas of staining will be the scored
area and areas with guttata. (Turn off infusion while injecting the VisionBlue® into
the eye.). If Descemet’s membrane fragments, a second dose of VisionBlue® can be
injected to better see tags and residual pieces of membrane.
8. Strip Descemet’s membrane with Moria Stripper #19077, opening up the temporal
incision as needed. Usually the 90 degree stripper is all that you will need.
9. Place removed Descemet’s on cornea to verify enough, or correct amount of
Descemet’s membrane removed.
10. Extend temporal incision to its full length.
11. Remove the infusion line.
Donor Placement
1. Transfer donor to operative field with spatula if donor on block, or remove from
trephine.
2. Place donor on patient’s cornea.
Preparation of “Taco” (Right-handed)
1. Hold onto right side of donor at epithelial edge and place small amount of viscoelastic
on mid-portion of left side of donor.
2. Use other forceps to fold endothelial side to the left, leaving more donor on the upper
half.
3. Gently slip Moria Goosey forceps #19090 (that grasp only at the tip) around the taco
without overly squeezing the tissue.
Insertion and Unfolding of Donor
1. Gently lift wound and insert “taco” into A/C with donor as close to left side of A/C
angle as possible.
2. Remove Moria Goosey forceps without pulling out or dislodging donor.
3. Optional: place 10-0 nylon fixation suture(s) to completely close scleral tunnel
incision.
4. Fill AC partially with BSS through right paracentesis.
5. Suture edge of donor in eyes with narrow angles, vitrectomy, very thin donors, or
instability of lamellar graft.
April 2006 2/3