Descemet Stripping endothelial keratoplasty donor graft dissection following bowman-stromal Inlay preparation

Abstract

This article outlines the dissection of donor grafts in descemet’s stripping endothelial keratoplasty (DSEK) after Bowman–Stromal inlay (BSI) tissue preparation. Following the femtosecond (FS) laser-assisted BSI for stromal augmentation in keratoconus, the donor cornea is transitioned to an artificial anterior chamber. The dissection of the DSEK graft is meticulously performed using blunt dissectors, considering the varying tissue thickness (thinner at the center and gradually thickening toward the periphery). This approach was successfully employed in three corneal donor tissues, facilitating six surgeries—three BSI and three DSEK. The intraoperative and postoperative courses were uneventful. This technique demonstrates the feasibility of utilizing a single donor tissue for both stromal augmentation and posterior lamellar keratoplasty (DSEK). Notably, the endothelial integrity of the donor tissue appears to remain unaltered following FS laser and subsequent manipulation by blunt dissectors. This holds promise in optimizing the utility of donor corneas for multiple therapeutic interventions.