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 0.5 mm smaller than the graft from between 1 quadrant to 360 degrees, preferably in two opposite quadrants. Using the Jacob technique of pressurized air infusion (air pump-assisted PDEK), the host Descemet membrane is gently teased from under the graft with a reverse Sinskey hook and allowed to overlap the graft from the posterior aspect in a scaffolding manner. Wound scaffolding within the incision is attained by pulling any overlapping part of the graft into the inner part of the corneal incision instead of allowing it to lie posterior to the inferior lip. Both these scaffolding maneuvers give an extra degree of scaffolding or support that provides graft stability and thereby decreases the risk for graft detachment.