PMC3267538_01
Preoperative appearance of right eye of patient. Best corrected visual acuity counting fingers at 1 m.
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The corneas of both eyes were diffusely edematous (Figure 1), with central corneal thicknesses of 921 mum and 891 mum in the right and left eyes respectively, measured with ultrasonic pachymetry. The corneal stroma, although it became clearer, did not become totally transparent, with moderate residual stromal haze being present even at 1 year while the central corneal thickness was 658 mum (Figure 4A - postoperative appearance at 2 weeks; Figure 4B - appearance at 1 month postoperatively; Figure 4C - postoperative appearance at 3 months; Figure 4D - postoperative appearance at 1 year).
(A) intraoperative view of cornea after debridement of corneal epithelium; (B) scouring of Descemet's membrane using a reverse Sinskey hook; (C) stripping of Descemet's membrane from the overlying corneal stroma with a 90  Descemet's stripper; (D) performing a peripheral iridectomy with a vitrector; (E) pulling the endothelial graft into the anterior chamber; (F) unfolding of the graft in anterior chamber; (G) an air bubble is injected under the graft; (H) centration of the donor disc by massaging the epithelial surface of the cornea with an irrigating cannula.
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AC (Figure 2A). A 1-mm side port was created at the 6 o'clock position, through which an AC maintainer was inserted and the irrigating fluid turned on. A 2.75-mm temporal clear corneal incision was created, through which Descemet's membrane (DM) scouring was performed at the required diameter using a reverse Sinskey hook (Figure 2B). AC. The AC maintainer was then turned back on to wash the dye out of the AC. A 90  Descemet's stripper was then used to strip DM from the overlying corneal stroma (Figure 2C). A peripheral iridectomy was performed at the 11 o'clock position using a vitrector (Figure 2D). AC (Figure 2E) and allowed to unfold spontaneously under continuous irrigation from the AC maintainer (Figure 2F). An air bubble was injected under the graft and the AC maintainer was turned off (Figure 2G). The epithelial surface was then gently massaged using a blunt, bent, irrigating cannula centered on the disk (Figure 2H).
Injection of a large air bubble into the anterior chamber at the conclusion of the procedure.
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AC to keep the disc adherent to the overlying stroma for around 15 minutes (Figure 3). At the conclusion of the procedure, some air was exchanged with balanced salt saline (BSS), reducing the bubble size to approximately 2/3rd of the AC volume.
(A) postoperative appearance at 2 weeks; (B) postoperative appearance at 1 month; (C) postoperative appearance at 3 months; (D) postoperative appearance at 1 year.
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The corneal stroma, although it became clearer, did not become totally transparent, with moderate residual stromal haze being present even at 1 year while the central corneal thickness was 658 mum (Figure 4A - postoperative appearance at 2 weeks; Figure 4B - appearance at 1 month postoperatively; Figure 4C - postoperative appearance at 3 months; Figure 4D - postoperative appearance at 1 year).