Graft insertion during Descemet-stripping automated endothelial keratoplasty: pulling the graft inward

We describe a technique to facilitate insertion of the folded donor graft during Descemet-stripping automated endothelial keratoplasty (DSAEK). Surgery is performed using a standard technique, and the graft is pulled into the anterior chamber using a double-armed 10-0 polypropylene suture with straight 16 mm needles. The technique of pulling the graft inside the anterior chamber is easy and ensures that the graft is inserted and unfolded in the right direction. There is no compression of tissue so mechanical trauma to the endothelium is less than when an inserting forceps is used. The results in 12 cases are presented.