title: Transcorneal suture fixation of posterior lamellar grafts in eyes with minimal or absent iris-lens diaphragm.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Ophthalmology, Villa Serena Hospital, Forlì, Italy. amitpatel@doctors.org.uk
authors.forename: Amit K
authors.initials: AK
authors.lastname: Patel
authors.forename: Saverio
authors.initials: S
authors.lastname: Luccarelli
authors.forename: Diego
authors.initials: D
authors.lastname: Ponzin
authors.forename: Massimo
authors.initials: M
authors.lastname: Busin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001036:Aphakia, Postcataract / Q000150:complications / Q000601:surgery*; D003315:Cornea / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007499:Iris Diseases / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D019591:Pseudophakia / Q000150:complications / Q000601:surgery*; D012029:Refraction, Ocular / Q000502:physiology; D013536:Suture Techniques; D014792:Visual Acuity / Q000502:physiology