Descemet's stripping automated endothelial keratoplasty in intraoperative floppy-iris syndrome: suture-drag technique

Descemet's stripping automated endothelial keratoplasty avoids a full-thickness corneal procedure and provides rapid visual rehabilitation. Success depends on positioning the graft successfully while minimizing intraoperative donor endothelial trauma. Previously described techniques for graft insertion may be problematic in patients with intraoperative floppy-iris syndrome, anatomically shallow or unstable anterior chambers, or increased intraoperative posterior vitreous pressure. We describe an alternative called the suture-drag technique that may facilitate lamellar endothelial graft insertion in these special circumstances.