Descemet's stripping automated endothelial keratoplasty in abnormal anterior segment: scleral indentation technique to enhance donor adherence.

Background: To describe a scleral indentation technique to enhance donor adherence in Descemet's stripping and automated endothelial keratoplasty (DSAEK) in patients with abnormal anterior segment.

Methods: In patients with visual potential, we performed transscleral fixation of a foldable intraocular lens (IOL) and DSAEK. In patients only for pain relief, we performed DSAEK without IOL implantation. During air tamponade, we injected only a medium air bubble instead of big bubble into anterior chamber and used scleral indentation technique as an aid. The position of the grafts was checked by the slit lamp and anterior segment optical coherence tomography (AS-OCT).

Results: Five eyes of five patients of aphakic bullous keratopathy (ABK) or pseudophakic bullous keratopathy (PBK) with anterior chamber IOL (AC IOL) were included in this non-comparative interventional case series. The grafts attached well in all patients without any graft dislocation intraoperatively and during the follow-up period. There was no pupillary block or peripheral anterior synechiae postoperatively.

Conclusions: Scleral indentation technique with or without transscleral fixation of a foldable IOL in DSAEK can facilitate the air tamponade and enhance the donor adherence in certain anterior segment abnormities.