Transcorneal suture fixation of posterior lamellar grafts in eyes with minimal or absent iris-lens diaphragm

• Purpose: To describe a technique that uses a transcorneal suture for safe delivery and fixation of donor tissue during Descemet stripping automated endothelial keratoplasty in patients that are at risk of graft dislocation into the vitreous cavity as a result of minimal or absent iris-lens diaphragm. • Design: Interventional case series. • Methods: Thirteen eyes with endothelial decompensation and inadequate iris-lens diaphragm underwent modified Descemet stripping automated endothelial keratoplasty surgery. A 10-0 Prolene suture (Ethicon Inc) was passed through the endothelial graft and used to pull the graft into the eye and anchor it onto the recipient cornea. Best-corrected visual acuity, refraction, and complications were recorded. • Results: Preoperative best-corrected visual acuity was less than 20/200 in all cases. Eleven patients had a pre-existing comorbidity (glaucoma, n = 8; previous retinal detachment, n = 2; epiretinal membrane n = 1). Average follow-up was 11.3 months (range, 3 to 36 months). No graft dislocation occurred during surgery. After surgery, graft detachment was noted in 2 cases and rebubbling succeeded in achieving reattachment. All patients had successful attachment of the endothelial graft. Postoperative best-corrected visual acuity improved in 11 of 13 patients and remained unchanged in 2 patients. • Conclusions: In patients with insufficient iris-lens diaphragm, this technique allowed safe graft delivery, prevented intraoperative and postoperative graft dislocation, and facilitated successful rebubbling in case of postoperative graft detachment. © 2011 Elsevier Inc.