Descemet membrane automated endothelial keratoplasty: hybrid technique combining DSAEK stability with DMEK visual results.

We describe an endothelial keratoplasty technique in which Descemet membrane is transplanted with a peripheral ring of corneal stroma. As in Descemet stripping automated endothelial keratoplasty (DSAEK), a microkeratome resects an anterior corneal cap. A big-bubble technique is then used to detach the central 6.0 to 7.0 mm of Descemet membrane. The scleral rim is again mounted on an artificial anterior chamber. The stroma overlying the big bubble is excised and the tissue punched with an 8.5 to 9.0 mm trephine. This leaves a bare central Descemet membrane with an attached peripheral rim of stroma. The graft is inserted using methods previously described for DSAEK. The graft's stromal rim allows it to spontaneously unfold once inside the eye. The Descemet membrane automated endothelial keratoplasty transplantation technique combines the superior vision potential of Descemet membrane endothelial keratoplasty with the easier insertion and manipulation of DSAEK.