DSAEK surgery was performed using double-glide technique51 (link). After retrobulbar anesthesia with injection of 2% lidocaine, a 5.0-mm temporal corneoscleral incision was made. An AC maintenance cannula was inserted through the 2 or 10 o’clock paracentesis, and Descemet stripping was performed with a reverse-bent Sinsky hook (Asico, Westmont, IL, USA). The recipient’s endothelium and Descemet’s membrane were carefully removed using forceps. Pre-cut donor grafts were trephinated at a diameter of 7.0–8.5 mm, and the endothelial surface of the donor lenticle was coated with a small amount of viscoelastic material. Donor tissue was gently inserted into the anterior chamber using a Busin glide (Asico) and Shimazaki DSAEK forceps (Inami, Tokyo, Japan). Air was carefully injected into the anterior chamber to unfold the graft. The fluid between the recipient’s stroma and the graft was drained from small incisions in the midperipheral recipient cornea. At 10 min after air injection, half of the air was replaced by balanced salt solution (BSS, Alcon, Fort Worth, TX, USA). At the end of the surgery, 2 mg subconjunctival betamethasone was administered. In patients with significant lens opacity (82 eyes), standard phacoemulsification and aspiration were performed using the phaco-chop technique with implantation of an IOL, followed by the DSAEK procedure. Postoperative medications included levofloxacin (Cravit, Santen, Osaka, Japan) and 0.1% betamethasone sodium phosphate (Sanbetazon, Santen), which were prescribed five times per day for 3–6 months. Topical 0.1% fluorometholone was prescribed two times per day after cessation of topical betamethasone.
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