Surgery: Air Bubble Complications in DSAEK

This video demonstrates the complications during air injection during DSAEK and shows the ways to accomplish the air injection by taking some precautions.

Surgery location: on-board the Orbis Flying Eye Hospital
Surgeons: Orbis Volunteer Faculty


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Dr. Javed Farooqui: Since its introduction in 2001, Descemet’s Stripping Endothelial keratoplasty or DSAEK has proved to be an effective way of addressing endothelial problems while minimizing other complications. During DSAEK after the folded graft is injected through a small incision in the anterior chamber, the wound is sutured before injecting the air. Air Injection is an essential step for successful surgery. If the wound is not secured, the air would not hold in the anterior chamber. Once the graft is unfolded, the injected air should achieve 90 to 100 percent fill of the anterior chamber. In certain cases specially eyes with peripheral iridotomy, the air can easily escape to the posterior chamber. In such cases, the air should be injected very slowly. The anterior chamber needs to be fully formed with air to make sure that the graft is in place to have a successful outcome. If the surgeon injects air without securing the wound and the air escapes to the posterior chamber behind the iris, it starts a vicious circle of air injection and air escaping to the posterior chamber. This pushes the iris forward and may result in shallowing of the anterior chamber and even iris prolapse. Injecting more air at this time will only result in further shallowing of the anterior chmaber and increasing the surgeon’s stress levels. Note that the air keeps escaping from the wound and the anterior chamber is not formed. The surgeon at this stage needs to stop, sit back and take a deep breath. At this stage remove the air in the anterior chamber and from behind the iris.

Take a suture and close the main incision. If the problem persists close the side ports. Once the wound is secure, refill the anterior chamber with air. Even though air injection is simple step, it is a very important step of the surgery and can easily go wrong. Key to success is, to pick up the complication early and suture the wounds before further manipulation.

August 22, 2017

Last Updated: October 31, 2022

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