Modified air-assisted descemetorhexis for Descemet-stripping automated endothelial keratoplasty

Descemet-stripping automated endothelial keratoplasty (DSAEK) is an alternative to penetrating keratoplasty for the treatment of corneal endothelial disease that involves stripping diseased Descemet membrane (DM) from the recipient. Descemet membrane stripping is currently performed with a generic balanced salt solution (BSS) or an ophthalmic viscosurgical device in the anterior chamber, but limitations of these techniques include poor visualization of DM and difficulty maneuvering loose DM. We describe a simple modified technique to perform descemetorhexis under air that improves visualization, even in cloudy corneas, and aids in control of DM because of the enhanced surface tension from the air-fluid interface on the posterior corneal surface.