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Stromal Lamellar Dissection of the Donor Disc: A Technique to Reduce Complications Secondary to Eccentric Trephination During Descemet Stripping Automated Endothelial Keratoplasty

Purpose: To describe a surgical technique to decrease the incidence and potential complications of an eccentric trephination and improve graft adherence during Descemet stripping automated endothelial keratoplasty. Methods: Technique description. Results: After resection of the anterior lamella with the microkeratome, the corneoscleral rim in the artificial anterior chamber (AC) is brought under view of the operating microscope and the deep dissection plane of the microkeratome is extended 360 degrees as far peripherally as permitted by the Moria artificial anterior chamber using a crescent blade and 0.12-mm Colibri forceps. The central stroma is marked with gentian violet, and the donor button is released from the AC and then carefully placed and centered on the punching block endothelial side up using the gentian violet mark as a guide and trephined to the desired diameter. The donor graft may then be inserted by the surgeon's preferred technique. Conclusions: This simple technique allows the surgeon to consistently increase the lamellar dissection diameter while reducing the peripheral graft thickness, which becomes particularly important when the trephination is eccentric. This technique may lead to improved donor adherence and a decrease in the incidence of donor lenticule configuration -related complications.