Abstract
PURPOSE: This study aimed to describe a novel technique of direct anterior chamber (AC) air replacement (DACAR) for the management of Descemet stripping automated endothelial keratoplasty (DSAEK) in postvitrectomized eyes and eyes with previous glaucoma surgery. METHODS: DACAR was performed after a corneal donor graft was transplanted through a wound using the pull-through technique. DACAR involves stabilizing the graft with forceps while introducing air into the AC via an infusion cannula to ensure complete air exchange. The air was maintained in the AC at all times using a vitrectomy machine. The air pressure was maintained at 30 mm Hg for 15 minutes. RESULTS: The DACAR technique was performed in 34 patients, and conventional pull-through technique DSAEK was performed in 32 high-risk patients. The DACAR group had shorter DSAEK surgical procedures ( P = 0.009) and a lower incidence of corneal graft detachment in the early postoperative period ( P < 0.001) than the conventional DSAEK group. CONCLUSIONS: DACAR is performed in patients having previously undergone vitrectomy or glaucoma surgery to prevent corneal graft detachment during the early postoperative period and to reduce the length of surgery.