Native means of graft stabilization: Host descemetic scaffolding and wound scaffolding to decrease the risk for graft detachment in DMEK and PDEK.

The main postoperative complication of Descemet membrane endothelial keratoplasty and pre-Descemet endothelial keratoplasty (PDEK) is graft detachment. We report a technique in which the host Descemet membrane or the incision is used for graft scaffolding. The descemetorhexis is created 0.

Fibrin Glue-Assisted Closure of Macroperforation in Predescemetic Deep Anterior Lamellar Keratoplasty With a Donor Obtained From Small Incision Lenticule Extraction.

Purpose: To report a case with multiple macroperforations and a double anterior chamber (AC) after predescemetic deep anterior lamellar keratoplasty.

Methods: A patient was referred after undergoing complicated excision of pseudopterygium that extended onto the cornea. At presentation, an eccentric lamellar patch graft extending over the pupillary axis with a double AC was seen.

Primary Modified Predescemetic Deep Anterior Lamellar Keratoplasty in Acute Corneal Hydrops.

Purpose: To report primary treatment of acute corneal hydrops (CH) with a modified technique of predescemetic deep anterior lamellar keratoplasty (pdDALK).

Methods: This prospective interventional case series included 9 eyes with acute CH that underwent pdDALK as primary treatment. Technique modifications included a bevel-up needle, creating tissue emphysema as a guide for dissection, using small aliquots of air directed away from break, manual deeper dissection using a blunt dissector, centripetal dissection leaving the area of Descemet membrane (DM) break for last, retention of minimal stroma above DM tear, and tamponade of DM tear with air in the anterior chamber.

Combined interface tattooing and fibrin glue-assisted sutureless corneal resurfacing with donor lenticule obtained from small-incision lenticule extraction for limbal dermoid.

We describe a technique of small-incision lenticule extraction (SMILE)-assisted sutureless corneal resurfacing with interface tattooing for superficial limbal dermoids. After excision at a plane minimally below surrounding normal cornea and sclera, a corneal tattoo powder is carefully applied within an inked circular outline of the intended corneal margin. Circularity and cosmesis are assessed in natural light with the microscope light off.

Air Pump-Assisted Graft Centration, Graft Edge Unfolding, and Graft Uncreasing in Young Donor Graft Pre-Descemet Endothelial Keratoplasty.

Purpose: To assess an air pump-assisted technique for graft centration, graft edge unfolding, and graft uncreasing while performing pre-Descemet endothelial keratoplasty (PDEK) using young donor grafts.

Methods: Continuous pressurized air infusion was used for graft centration, graft edge unfolding, and graft unwrinkling.

Results: Ten eyes of 10 patients underwent PDEK with donors aged below 40 years.

Supracapsular glued intraocular lens in progressive subluxated cataracts: Technique to retain an intact vitreous face.

We describe a technique to prevent late intraocular lens (IOL) subluxation and dislocation that can be associated with progressive zonulopathy. Supracapsular glued IOL fixation is done to retain an intact anterior hyaloid face and avoid vitreous disturbance while providing stable long-term IOL fixation. Phacoemulsification is followed by glued IOL implantation above intact anterior and posterior capsules.

A new clinico-tomographic classification and management algorithm for Descemet's membrane detachment.

Objective: To propose a new clinico-tomographic classification of Descemet's detachment (DD).

Methods: Interventional case series of 35 eyes with DD were clinico-tomographically classified as: (1)Rhegmatogenous DD (RDD)-lax, free floating DM secondary to DM tear/hole/dialysis; ASOCT showing undulating linear signal with total length equalling overlying stromal arc length. (2) Tractional DD (TDD)-foreshortened, taut DM with tractional/fibrotic component; ASOCT showing detached DM chord length less than overlying stromal arc length.

Closed-chamber haptic reexternalization for posteriorly displaced sclerotomy and inadequate haptic tuck in glued posterior chamber intraocular lenses.

Unlabelled: The glued posterior chamber intraocular lens (PC IOL) requires externalization of a sufficient length of both haptics to obtain an adequate intrascleral tuck, which is vital for stable IOL fixation. One cause of a decreased length of externalized haptic may be a sclerotomy that is inadvertently placed posteriorly. We describe a technique to handle this situation by creating a fresh sclerotomy anterior to the first one, followed by internalizing the haptic and reexternalizing it through the new sclerotomy.

Glued capsular hook: technique for fibrin glue-assisted sutureless transscleral fixation of the capsular bag in subluxated cataracts and intraocular lenses.

We describe a technique that uses a capsular hook to obtain sutureless fibrin glue-assisted transscleral fixation of the capsular bag. The hook passes through a sclerotomy created under a scleral flap and engages the capsulorhexis rim, providing scleral fixation intraoperatively and postoperatively. A standard capsular tension ring expands the capsular fornix.

Endoilluminator-assisted transcorneal illumination for Descemet membrane endothelial keratoplasty: enhanced intraoperative visualization of the graft in corneal decompensation secondary to pseudophakic bullous keratopathy.

Unlabelled: Compromised visibility is problematic with Descemet membrane endothelial keratoplasty (DMEK), especially in the presence of corneal edema. Visibility may be enhanced by dehydrating the cornea preoperatively and by debriding the epithelium, staining the graft, and using a handheld slitlamp during surgery. Because the DMEK graft is transparent, thin, and flimsy, it is difficult to confirm the position, orientation, and morphology even with a clearer cornea.

Glued intraocular lens scaffolding to create an artificial posterior capsule for nucleus removal in eyes with posterior capsule tear and insufficient iris and sulcus support.

Glued IOL scaffolding decreases the chance of nucleus drop in eyes with insufficient iris and capsule support. The advantages include no temporary device or substance that must be removed after nucleus emulsification, ability to perform complete surgery without enlarging incisions, stable fixation of the IOL, compartmentalization of the eye, and decreased vitreous hydration and aspiration. The IOL is preplaced via glued transscleral haptic fixation of the IOL.

Handshake technique for glued intrascleral haptic fixation of a posterior chamber intraocular lens.

We describe a technique for easy externalization of the haptics for glued intrascleral fixation of a posterior chamber intraocular lens (IOL). The "handshake" technique is a modification of the glued-IOL procedure in which the IOL haptic is bimanually transferred from one glued IOL forceps to another under direct visualization in the pupillary plane. The modification provides better intraocular maneuverability throughout the surgery and extends applicability of the technique to challenging cases that require haptic manipulation, such as IOL drop and haptic slippage.

Safety and efficacy of gas-forced infusion (air pump) in coaxial phacoemulsification.

Purpose: To evaluate the safety and efficacy of gas-forced infusion (air pump) in uncomplicated coaxial phacoemulsification.

Setting: Dr. Agarwal's Eye Hospital, Chennai, India.