Preparation of ultrathin grafts for Descemet-stripping endothelial keratoplasty with a single microkeratome pass

Abstract

We present a technique to achieve ultrathin Descemet-stripping automated endothelial keratoplasty (DSAEK). Using a simple method of controlling artificial anterior chamber pressure and drying the corneal surface, it was possible to thin the donor cornea at a rate of 11μm a minute. When the donor cornea was between 500μm and 510μm, a single pass was madeusinga 350μm microkeratomehead followed by a peripheral dissection. The resultingmean graft thickness was 83.2μm±14.9 (SD) (range 50 to 98μm) with a mean peripheral graft edge thickness of 106.8±10.9μm (range 90 to 120μm). There were no surgical complications, and all grafts remained attached. This is a reliable method for preparing ultrathin donor corneal lenticules for DSAEK in the operating room or eye bank without using multiple microkeratome heads or risking double passes.