TechniquesEye Bank Management of Irregular Descemet Stripping Automated Endothelial Keratoplasty LenticulesRuzza, Alessandro BSc*; Galeone, Alessandra MD†; Baruzzo, Mattia*; Favaro, Elisa*; Parekh, Mohit PhD‡; Ferrari, Stefano PhD*; Ponzin, Diego MD* Author Information *The Veneto Eye Bank Foundation, Venice, Italy; †Ophthalmology Department, Azienda Ospedaliera Universitaria Policlinico di Bari, Bari, Italy; and ‡Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, United Kingdom. Correspondence: Alessandro Ruzza, BSc, The Veneto Eye Bank Foundation, Padiglione G. Rama, Via Paccagnella 11, 30174 Venice, Italy (e-mail: [email protected]). The authors have no funding or conflicts of interest to disclose. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.corneajrnl.com). Cornea: June 2021 - Volume 40 - Issue 6 - p 786-789 doi: 10.1097/ICO.0000000000002539 Buy SDC Metrics Abstract Purpose: To report the management of precut Descemet stripping automated endothelial keratoplasty (DSAEK) lenticules unsuitable for transplantation because of irregular anterior profile after microkeratome cutting. Methods: After preparation for DSAEK, 20 tissues were considered unsuitable for transplantation because of nonhomogeneous posterior stromal thickness. To convert them into suitable tissues for surgery, manual stromal delamination was performed by removing the excess stromal layers after the indications obtained through optical coherence tomography. These tissues were further transplanted as ultrathin DSAEK. Results: Nineteen tissues were delaminated successfully. The average reduction in thickness in the center (63 ± 69 μm; P = 0.0101) and periphery (129 ± 39 μm; P < 0.0001) before and after delamination was significantly different. One tissue showed signs of perforation during manual dissection and therefore considered unsuitable for transplantation. Primary graft failure was reported in one case, but it was not correlated with the tissue preparation. No other clinical complications were observed after surgery. Conclusions: Manual delamination of the stroma because of irregular microkeratome cutting is a viable option to obtain a uniform graft thickness required for DSAEK surgeries. This technique can further reduce tissue wastage that is observed after microkeratome cutting errors. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.