Endothelial Keratoplasty Safety-Basket Suture for Management of Difficult Cases.

PURPOSE: To describe a novel technique of a safety-basket for management of Descemet stripping automated endothelial keratoplasty in eyes with defects of the lens-iris diaphragm, postvitrectomized eyes, eyes with previous glaucoma tube-shunt or trabeculectomy, or when the patient cannot lie supine.

METHODS: The safety-basket suture is placed after the endothelial graft has been positioned under air and all wounds have been closed. Double-armed 10-0 polypropylene suture on a curved needle is passed under the graft in a single-running fashion, a modification of the Masket technique used as a safety suture in the management of malpositioned intraocular lenses. Care is taken not to touch the graft with the needle or suture. The suture can be left in place and removed at the slit-lamp postoperatively with continued use of topical antibiotics while the safety-basket is left in place.

RESULTS: The technique was used successfully for 35 high-risk cases with good success with no cases of postoperative infection.

CONCLUSIONS: Endothelial keratoplasty safety-basket sutures, when used in high-risk Descemet stripping automated endothelial keratoplasty patients with abnormal anterior segment anatomy can provide support to maintain the graft in a central position and thus allow for easier rebubbling, should it detach in the early postoperative course.