Endothelial keratoplasty in patients with endothelial dysfunction of various etiologies, combined with abnormality of the iris-lens diaphragm

The article presents a description of a modified method of transplantation of the endothelium on descemet membrane and of a method of femtosecond laser-assisted posterior lamellar keratoplasty in patients with corneal endothelial dysfunction combined with severe defects of the iris-lens diaphragm integrity. During surgery, in both cases, a banded stromal flap was used. There were no complications in the early postoperative period. The air resorption in the anterior chamber in both cases lasted no more than 2 days. After air resorption, the stromal flap occupied an intermediate position between the iridolens diaphragm remnants and the endothelial graft. On day 3, the bandage stromal flap was removed in the operating room. It was shown that the use of a bandage stromal flap during surgical procedures for extensive defects of the iris-lens diaphragm allows minimizing the risk of dislocation of the endothelial graft into the vitreal cavity. Proposed technique is an universal solution for DMEK and Fs-DSAEK in patients with an abnormality of the iris-lens diaphragm. The preliminary insertion of banded stromal flap into the anterior chamber makes it possible to block the defects of the iris-lens diaphragm and provides conditions for prolonged air tamponade of the anterior chamber and primary graft adhesion.