To evaluate visual acuity, refractive outcomes, and endothelial cell density 12 months after minimal Descemet stripping automated endothelial keratoplasty (DSAEK) in the treatment of endothelial dysfunction.

We performed an institutional review board-approved prospective study of a surgical case series of 12 patients, undergoing DSAEK for Fuchs endothelial dystrophy, pseudophakic bullous keratopathy, or aphakic bullous keratopathy. A single 3.2-mm limbal corneal incision provided access for descemetorhexis in a stable anterior chamber, then a 7.5- to 8.0-mm posterior lamellar disc of donor cornea was put on a smooth ocular surface provided by one drop of dispersive viscoelastic material and transferred through the incision into the anterior chamber.

Twelve months after surgery, all grafted discs of cornea were healed in good position and corneas were clear. BSCVA improved from 0.92±0.09 logMAR to 0.30±0.12 logMAR (P=0.01), the keratometric astigmatism changed an average of 0.1±0.03 diopters (D) (p=0.38), and the average pachymetry was 598±38 µm. The mean ECD changed from 2768±205 cells/mm2 to 2491±184 cells/mm2 at 12 months which represented a 10% cell loss (P=0.04). No significant complication appeared during this time.

The minimal incision DSAEK procedure is a safe technique minimizes donor endothelial cell loss and astigmatism changes. Considerable advantages are stability of the anterior chamber during surgery, no need for irrigation side port or specific instrument for donor disc delivery. Also, this approach preserves the donor endothelial cell count and shortens the duration of the operation and reduces damage to the graft endothelium.