Closed-chamber pulling-injection system for donor graft insertion in endothelial keratoplasty.

I describe the closed-chamber pulling-injection (CCPI) technique to improve surgical control and safety of graft insertion into the anterior chamber during Descemet-stripping automated endothelial keratoplasty (DSAEK). In CCPI, the graft is rolled up (endothelium facing inward) in a closed transparent insertion device, allowing it to be drawn into a well-formed anterior chamber and unfolded smoothly. The technique has been used successfully to treat corneal decompensation in 72 consecutive cases. The results indicate that using the CCPI technique, both average and complicated cases can benefit from the numerous advantages provided by endothelial keratoplasty.