Descemetorrhexis in endothelial keratoplasty to avoid peripheral bullous keratopathy

Descemet-stripping automated endothelial keratoplasty has revolutionized the treatment of corneal endothelial disease. This procedure requires the removal of the Descemet membrane (DM) and the endothelium from the recipient cornea. We describe a simple technique to perform descemetorrhexis using an ophthalmic viscosurgical device to fill the anterior chamber and using capsulorrhexis forceps to create a controlled, continuous curvilinear DM tear in 19 cases. Avoidance of tearing the DM out to the periphery reduces endothelial cell loss, decreases migration of central endothelium to deficient areas, and minimizes the risk for chronic corneal edema and peripheral bullous keratopathy.