Abstract

Phaco with DSEK in ICES is always challenging as ACD is irregular -shallow for PAS .As horizontal corneal diameter was 10.2 mm, 8mm DSEK graft taken .Phaco part was uneventful but while graft was inserting in Taco 60:40 Fashion it was slipped in to 40:60 accidentally as it was ultra-thin graft .its very difficult to unfolds as graft was not getting any space for unfolding ,gave air in between folds and try to unfolds by revers sinsky was not succeed ,secure the main wound by sutures and after repeated attempts with hydro injections in between folds was able to unfolded the graft and AC formed with air ,immediate post op was uneventful and after 6weeks was 6/36 , clear graft and after 6months BCVA was 6/12,N8.If I would have taken small graft 7.5mm and additionally use ACM ,would have complete the surgery smoothly.So depending on,on table finding ,size of DSEK graft ,insertion technique can be planned to overcome adverse situation – This is the Surgical pearls of my presentation