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Modification in Descemet-Stripping Automated Endothelial Keratoplasty: “Hitch Suture” Technique

Purpose: To describe a new modification in Descemet-stripping automated endothelial keratoplasty, using a “hitch suture” to unfold the donor lenticule inside the recipient's eye. Methods: The technique was used in 2 eyes of 2 patients with bullous keratopathy after complicated cataract surgery. A hitch suture was created in both the donor lenticules before inserting the folded graft in the recipient's anterior chamber. The hitch suture was pulled through a limbal stab incision to unfold the donor lenticule in both cases. Results: No intraoperative problems were encountered. The grafts were well centered with corneal edema. The central part of the graft cleared over a period of 10 to 14 days. Conclusion: The technique of using a hitch suture to unfold the graft eliminates the problems associated with this difficult step of the surgery. The hitch loop can be easily made at the edge of the graft and can be pulled using a Sinskey hook through 1 of the stab incisions. We believe that this simple modification in this surgery would help simplify the learning curve of the procedure and increase its chances of success.