Outcomes of Sutureless Small Incision Descemet’s Stripping Automated Endothelial Keratoplasty: A Retrospective Study

Background: This study evaluated the outcomes of sutureless small incision Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK-SI) for treating corneal endothelial decompensation. Methods and Analysis: This retrospective study reviewed patients with corneal endothelial decompensation who underwent DSAEK-SI between January 2018 and June 2021 at the Vietnam National Eye Hospital. All patients were followed for at least one year postoperatively. The endothelial graft was inserted into the anterior chamber through a 2.8 mm main corneal incision using a Busin glide. The normal pressure air tamponade of the anterior chamber was applied to attach the graft to the recipient bed. The small incision required no sutures, and no need to remove part of the air from the anterior chamber. This ensured that the surgery ended immediately after the air tamponade, without having to wait for 15 min like with regular DSAEK. The patients were instructed to lie supine for at least 6 h postoperatively. Patients with cataracts underwent combined phacoemulsification and intraocular lens implantation with DSAEK-SI. Results: Sixty eyes from sixty patients were enrolled. The success rate of the surgery was 93.3%. Postoperatively, the best spectacle-corrected visual acuity (BSCVA) improved from 20/3600 to 20/400 at discharge and reached 20/100 at 12 months. Mild astigmatism (0.5D to 2D) was observed in 91.8% of patients, with a mean cylinder of 0.9 ± 0.4D at 12 months. The endothelial cell loss rate after 12 months was 34.6 ± 16%. No graft dislocations or detachments were recorded. Conclusions: The sutureless DSAEK-SI technique with a 2.8 mm incision is a modified technique that achieves high success rates and potentially reduces surgical manipulation and complications.