Flipping the inverted donor disk in descemet stripping automated endothelial keratoplasty

We describe a technique we used to flip the donor corneal lenticule during Descemet stripping automated endothelial keratoplasty. In this case, in which we performed standard phacoemulsification and intraocular lens implantation as a combined procedure with Descemet stripping automated endothelial keratoplasty, the donor lenticule unfolded upside down in the anterior chamber (AC). To flip the donor to a stromal side up position with minimum manipulation, we first passed in a needle and fixed it on the edge of the lenticule. This needle was used to push the edge of the lenticule upward while we filled up the AC with balanced salt solution, directing the fluid to push the distal edge down and away. Having flipped the lenticule halfway, the procedure was continued by placing the needle on the midperipheral stroma of the donor lenticule and sliding it toward the recipient cornea. Then, the AC was filled with air to allow adhesion of the donor, and at the end of surgery, the air was replaced with balanced salt solution. The cornea cleared over a period of 10 days after surgery. At the end of the fourth postoperative week, the final best-corrected visual acuity was 20/50.