Topical–intracameral anesthesia without preoperative mydriatic agents for Descemet-stripping automated endothelial keratoplasty and phacoemulsification cataract surgery with intraocular lens implantation

The video demonstrates combined phacoemulsification, IOL implantation, and DSAEK using topical and intracameral anesthesia. Injection of lidocaine 1% results in adequate dilation, which is augmented by the addition of an OVD. Iris dilation is maintained during cataract surgery, including capsulorhexis. Following phacoemulsification and IOL implantation, iris constriction occurs with irrigation and aspiration of the OVD from the anterior chamber. The DSAEK donor tissue is inserted into the anterior chamber with a mid-sized iris covering the lens and capsulorhexis. The anterior chamber is filled with air with a smaller pupil, permitting movement of the DSAEK donor tissue into final position.