Dear Editor: We describe a modification of Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) where the button insertion was performed in a sodium hyaluronate-filled anterior chamber. Nine consecutive patients (9 eyes) underwent DSAEK with the following technique. Sodium hyaluronate 10 mg/ml (Healon, AMO, Abbott Park, IL), a cohesive ophthalmic viscosurgical device (OVD) was placed into the anterior chamber throughout the procedure.
A suture-pull technique was used for graft insertion. Bimanual irrigation and aspiration cannulae (Alcon, Fort Worth, TX) were used to clear the anterior chamber from residual viscoelastic. The cannulae were inserted through the preplaced side port incisions and the irrigation bottle was lowered to minimize turbulence. In the first instance, the aspiration cannula was placed between the donor and recipient stroma while the irrigation cannula was placed under the donor button. This was then switched until no viscoelastic material could be discerned in the anterior chamber. An air bubble was then injected through 1 side port incision using a 30-gauge cannula. The pupil was dilated using cyclopentolate and the patient kept in a supine position for at least 60 minutes prior to discharge home.