Outcomes of Sutureless Small Incision Descemet's Stripping Automated Endothelial Keratoplasty: A Retrospective Study

Objective: To evaluate the outcomes of sutureless small incision Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK-SI) for treating corneal endothelial decompensation. Methods and analysis: This retrospective study involved sixty eyes of sixty patients with corneal endothelial decompensation who underwent DSAEK-SI between January 2018 and June 2021 at Vietnam National Eye Hospital. All patients were followed for at least one year postoperatively. The endothelial graft was inserted into the anterior chamber through a 2.8mm main corneal incision using a Busin glide. Normal pressure air tamponade of the anterior chamber was applied to attach the graft to the recipient bed. The small incision required no sutures with no need to remove part of the air from the anterior chamber and end the surgery immediately after air tamponade. Patients were instructed to lie supine for at least 6 hours postoperatively. Patients with cataracts underwent combined phacoemulsification and intraocular lens implantation with DSAEK-SI. Results: The success rate of the surgery was 93.3%. Postoperatively, the best spectacle-corrected visual acuity (BSCVA) improved from 20/3600 to 20/400 at discharge and reached 20/100 at 12 months. Mild astigmatism (0.5D to 2D) was observed in 91.8% of patients, with a mean cylinder of 0.9 ± 0.4D at 12 months. The endothelial cell loss rate at 12 months was 34.6 ± 16%. No graft dislocations or detachment were recorded. Conclusions: The sutureless DSAEK-SI technique with a 2.8mm incision is an innovative approach that reduces surgical manipulation, shortens operative time, and minimizes complications, resulting in high success rates and optimal outcomes.