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C. L. Springs, R. Deitch, Jr.; Technique to Ensure Proper Orientation of Donor Corneal Lenticule in Descemet's Stripping Endothelial Keratoplasy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4724.
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In Descemet's stripping endothelial keratoplasty, proper orientation of the donor corneal lenticule is critical for a successful result. The donor corneal lenticule consists of posterior stroma and endothelium. When properly positioned, the stromal surfaces of the host and donor corneal lenticule are apposed. Due to poor intraoperative visualization and tissue flaccidity, it is possible to improperly position the donor corneal lenticule so that the donor endothelium is apposed to the host stroma which results in an unsuccessful procedure and graft failure. We describe a technique to reduce the likelihood of this complication.
The donor corneal lenticule (n=6) was precut so that the anterior 250 microns were removed with a microkeratome by the preparing eyebank. The donor corneal lenticule was then cut with an 8.5mm trephine. Viscoelastic was then placed on the endothelium prior to folding the donor tissue so that the endothelial surfaces were apposed. Using a Sinskey hook inked with trypan blue, an "S" was drawn on the donor stromal surface. The donor corneal lenticule was inserted into the host anterior chamber, unfolded and elevated into position with a filtered air bubble and centered with a reverse Sinskey hook.
In all cases, the inked "S" was readily visible through the host stroma. The "S" appeared in its proper orientation when the donor corneal lenticule was correctly positioned with the host and donor stromal surfaces apposed and the donor endothelium facing the anterior chamber. If the donor corneal lenticule was improperly positioned, that is the donor endothelium apposed to host stroma, a backwards "S" was seen and appropriate corrective maneuvers were undertaken intraoperatively. Using this technique, the donor corneal lenticules were confirmed to be in their proper orientation.
Inking the stromal surface of the donor corneal lenticule with an "S" is an easy and effective way to ensure proper orientation. Trypan blue is nontoxic to anterior segment structures and is absorbed in the early postoperative period.
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