Abstract
The author reports the use of pars plana air-fluid exchange in promoting adhesion of the donor endothelial graft to the host cornea during Descemet's membrane stripping with endothelial keratoplasty in the absence of an intact lens-iris diaphragm. A three-port pars plana 25-gauge core vitrectomy is performed, followed by the insertion of the endothelial graft into the anterior chamber with a glide. After the limbal incision and the paracentesis site are sutured, the air-fluid exchange is done from the vitreous cavity toward the anterior chamber until the eye is completely filled with air. The air infusion pressure is maintained at 30 mm Hg for 10 minutes. The endothelial graft is centered with a roller. The pars plana cannulas are removed, and the scleral incisions seal spontaneously. This technique ensures that the anterior chamber is completely filled with air at the end of case and provides fine control of the intraocular pressure throughout the surgery.
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