The full-filling air technique: A case series of modified DSAEK in vitrectomized eyes without stable compartmentalization

Purpose To evaluate the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) combined with complete vitreous chamber fluid-air exchange via pars plana in vitrectomized patients with unstable compartmentalization between the anterior and posterior segment. Methods This case series presents a modified (full-filling) DSAEK technique, involving complete fluid-air exchange via pars plana, in six eyes with endothelial dysfunction and corneal edema who had undergone prior vitrectomy and lacked stable anterior-posterior segment compartmentalization (aphakic, iris-claw IOL, scleral fixed IOL, IOL in the ciliary sulcus). Preoperative and postoperative data, including visual acuity, corneal thickness, and endothelial cell density, were collected. The primary outcome was single-surgery graft adhesion; secondary outcomes included complications, re-bubbling rate, and visual acuity improvement. Results The full-filling DSAEK technique achieved complete graft adhesion in all cases at all follow-up visits, with improved visual acuity and decreased corneal thickness. No major complications were recorded, including donor graft dislocation and need of rebubbling. Conclusion When performing DSAEK, completely filling the ocular cavity with air via pars plana is a safe and effective technique in poorly compartmentalized vitrectomized eyes to achieve graft adhesion and improving surgical success.