Pre-Descemet’s Endothelial Keratoplasty

Preparation of the Recipient Eye

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This segment shows the preparation of the recipient eye before the PDEK graft is injected into the anterior chamber.

Keywords

  • PDEK graft
  • peri-bulbar block
  • hypertrophic epithelium
  • anterior chamber
  • peripheral iridectomy
  • vitrector probe
  • vitrectomy machine
  • fluid gas exchange system
  • Descemetorhexis
  • reverse Sinskey hook

Conflict of Interest

The author declares no conflict of interest.

About this video

Author(s)
Soosan Jacob
First online
01 April 2020
DOI
https://doi.org/10.1007/978-3-030-43833-3_2
Online ISBN
978-3-030-43833-3
Publisher
Springer, Cham
Copyright information
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2020

Video Transcript

This video shows preparation of the recipient eye before the beta graft is injected into the anterior chamber. A peribulbar block may be given. The patient’s eye is prepared and draped. The loose and hypertrophic epithelium in these eyes can hamper visualization during surgery. And this may be removed prior to surgery to be able to see better.

Paracentesis is then made with a 15-degree blade in order to place the anterior chamber maintainer. This is followed by making a partial entry of the main port. An anterior chamber maintainer is then introduced into the anterior chamber. And it is connected to pressurized air infusion given through of vitrectomy machine using the fluid-gas exchange system.

The peripheral iridectomy is then done using a vitrector probe in the inferior 6 o’clock position in order to prevent pupillary glaucoma in the postoperative period. The completeness of the PA is checked for. And since this is done under continuous air infusion, you can see that there is no bleeding from the peripheral iridectomy.

The size of the descemetorhexis that would be required is then estimated, and the host estimate is for scored using a reverse Sinskey hook, and this is followed by stripping it inwards gently. Since this is also done under the pressurized air infusion, you can see that the edges of the descemet’s membrane are very easily visualized. And you also get better control for doing the descemetorhexis.

The main port incision is now extended to its full length. It was not done so up to this stage of surgery, just so that a better formed anterior chamber could be maintained during all the required steps. The size of the obtained descemetorhexis is then once again estimated. And any residual tags are removed using a reverse Sinskey.