One of the great challenges faced by surgeons performing corneal endothelial transplantation is ensuring proper positioning and lasting adherence of the transplanted endothelial graft. Accomplishing donor adherence was noted as one of the largest early challenges in the successful development of the technique and remains a critical step of the procedure today.1 The importance of attaining adequate intraoperative placement is underscored by the rate of endothelial graft dislocations, which have been reported as high as 25% in Descemet stripping automated endothelial keratoplasty (DSAEK) and higher still in Descemet membrane endothelial keratoplasty (DMEK) and other more selective forms of endothelial transplantation.2
A number of techniques have been employed to promote graft adhesion, most of which focus on enhancing the dehydration of the donor–recipient interface. Classically, this has been achieved by a combination of air tamponade for 10 to 15 minutes and massage of the corneal surface to facilitate removal of sequestered fluid. The air tamponade is generally achieved via manual injection of air from a syringe. Price and Price described the utility of occasional supplementation of air with an infusion cannula through the paracentesis.