page_title: Pre-Descemet's Endothelial Keratoplasty
section_title: Graft Injection into Host Bed
hierarchical_section_title: Pre-Descemet's Endothelial Keratoplasty / Graft Injection into Host Bed
caption_attribution_description: The pictures describes the stages of a PDEK eye surgery
context_page_description: Pre Descemet's endothelial keratoplasty is a kind of endothelial keratoplasty, where the pre descemet's layer along with descemet's membrane and endothelium is transplanted. Conventionally in a corneal transplantation, doctors use a whole cornea or parts of the five layers of the cornea to perform correction surgeries. In May 2013, Dr Harminder Dua discovered a sixth layer between the stroma and the descemet membrane which was named after him as the Dua's layer. In the PDEK technique, doctors take the innermost two layers of the cornea, along with the Dua's layer and graft it in the patient's eye.
context_section_description: The PDEK graft which is already preserved in the storage medium is then placed in an injector (Fig 3A). The graft takes a shape of scroll immediately after dissection and the surgeons maintains the integrity or orientation of the scroll throughout the procedure. The injector along with the graft is inserted via the corneal wound and the graft is injected in the anterior chamber (Fig 3C). Initially the graft is made sure that it is oriented with endothelium down and PDL against the host stroma. This can be confirmed by using an endoilluminator because in eyes with corneal decompensation, the clarity is usually poor and the visualization of graft is affected under naked eye.8 once the orientation is confirmed, the graft is unfolded under saline (Fig 3D). Then the graft is attached to the overlying host stroma pneumatically (Fig 3E,F). Air fluid pressure is maintained inside the chamber for 60 seconds and then minimal air is released. The wound is closed with 10-0 monofilament suture and subconjunctival antibiotic steroid injection is given.
caption: Fig 3 : Graft injection into the host bed in combined PDEK with glued IOL. A: A central Big bubble formed in the donor cornea by pushing air into the cornea B,C: Flaps are made in the white sclera, IOL is inserted into the eye and the arms or haptics of the IOL is pulled out of the eye and attached to the white sclera in a tunnel and then glue is applied. The patient's damaged posterior part of cornea (descemet's membrane with endothelium) peeled manually. D: PDEK graft pushed into the eye under saline and opened. Endoilluminator or external light source is used to confirm the orientation of the graft. E, F: Donor graft is attached to the host stroma by air injection below the graft without sutures.
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