Single-Pass 4-Throw Pupilloplasty for Pre-Descemet Endothelial Keratoplasty

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Purpose:To describe the feasibility and applicability of the single-pass 4-throw pupilloplasty (SFT) technique in the Pre-Descemet endothelial keratoplasty (PDEK) procedure.Methods:In cases with endothelial decompensation and pupil deformity, SFT was performed to prevent the escape of air into the posterior segment. Fourier domain anterior segment optical coherence tomography was performed to analyze elevation of the iris and the suture tail end from the iris plane. In cases with aphakic bullous keratopathy, glued intrascleral (glued IOL) fixation was performed followed by SFT and PDEK, whereas in cases with pseudophakic bullous keratopathy due to malpositioned IOLs, the IOL was explanted followed by the glued IOL technique that was then followed by SFT with PDEK.Results:The procedure was performed in 9 eyes of 9 patients. The Fourier domain anterior segment optical coherence tomography image taken at the level of the iris demonstrated an elevation of the iris about 145 μm (longitudinal meridian, range 136–160 μm) and 165 μm (cross-section meridian, range 160–175 μm) from the adjoining iris plane. The end on view of the suture end was observed above the iris plane for about 47 μm (range 40–65 μm). Partial graft detachment was observed in 1 case. No incidence of primary graft failure or graft rejection during the entire follow-up period was reported in any of the eyes.Conclusions:SFT serves an effective technique for performing pupilloplasty in PDEK cases without the presence of a knot in the anterior chamber that poses a risk of mechanical damage to the donor graft.

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