case_images: PMC11439340_01
case_images: (A and B) The EndoArt (arrows) was spread over the spatula of the Busin glide to ensure correct orientation through an irreversible F letter; however, this is not very much visible in this video/screenshots. (C) The EndoArt was then pulled into the glide opening. (D) The glide was then inverted and positioned at the entrance of a nasal corneal tunnel. A 25-G Descemet's stripping automated endothelial keratoplasty (DSAEK) forceps was passed through a temporal paracentesis wound across the anterior chamber and grasped the edge of the EndoArt. (E) The donor lamella was pulled into the anterior chamber. The donor lamella was left to unfold spontaneously under continuous irrigation. (F) After securing the wound using a single 10-0 nylon suture, air was injected to attach the EndoArt to the posterior stromal surface. The reverse Sinskey hook was used to place the EndoArt to the desired central position of the cornea. One 10-0 Nylon suture was used to anchor the device to the stroma.
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case_images: Busin glide-assisted pull-through insertion, was used to implant the EndoArt (Figure 1A-F, Supplementary Video). Briefly, three paracentesis incisions were made at the 1, 9, and 10 o'clock positions, and a 2.7-mm clear corneal incision was made at the 3 o'clock position. To ensure correct orientation, a letter "F" symbol (Figure 1A and B), which was also visible using an endo-illuminator light, was used as a reference owing to its asymmetrical characteristics. The EndoArt was then pulled into the glide opening (Figure 1C). ASICO, Westmont, IL) was passed through a temporal paracentesis wound across the anterior chamber, and the edge of the EndoArt was grasped (Figure 1D). An AC maintainer was placed at the 10 o'clock position with minimal continuous irrigation. The EndoArt was pulled into the AC (Figure 1E). One 10-0 nylon suture at the 12 o'clock position was used to anchor the device to the stroma (Figure 1F).
case_images: (A and B) EndoArt attachment was confirmed using intraoperative spectral domain optical coherence tomography.
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case_images: EndoArt attachment was confirmed by intraoperative spectral-domain optical coherence tomography using ARTEVO800 (Carl Zeiss Meditec, Jena, Germany) (Figure 2A and B).
case_images: (A) Anterior segment optical coherence tomography image showing bullous keratopathy before surgery. The corneal thickness was 753 microm. (B) Postoperatively, the corneal thickness reduced to 530 microm with clearance of corneal edema. The eye pain also disappeared.
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case_images: The central corneal thickness (CCT) decreased from 845 mum to 530 mum (Figure 3A and B).