Manual preparation of donor lenticule using artificial anterior chamber for descemets membrane stripping endothelial keratoplasty

Purpose: To report a patient with a pseudophakic bullous keratopathy (PBK) who underwent Descemets membrane stripping endothelial keratoplasty (DSEK) with manual preparation of the donor corneal graft. Case summary: A 61-year-old female presented with visual disturbance in her right eye. Five months prior, she was treated with phacoemulsification and intraocular lens exchange surgery of the right eye, and a very severe corneal edema was revealed by slit-lamp examination. We diagnosed PBK and planned DSEK with manual preparation of a donor corneal graft because of the non-availability of a microkeratome or a femtosecond laser. After making the corneal graft using an artificial anterior chamber, crescent knife and cornea dissector, the keratoplasty proceeded using the graft. Three months after surgery, her graft was well-maintained on the right eye. The patient's visual acuity was 0.3, and the corneal endothelial cell count was 1,844/mm². Conclusions: Manual preparation of the donor corneal graft for DSEK is suitable as a second choice treatment method when the availability of surgical devices is limited.