Visualization and Determining Graft Orientation: Stamping, Endo-illuminator and Other Techniques

Visualization of graft orientation in the oedematous cornea can be challenging. Endothelial keratoplasty success ultimately depends on attaining the correct orientation of the graft within the anterior chamber with minimal intraoperative manipulation and endothelial cell loss. Both primary success and rebubbling success are dependent on these factors as well. This chapter aims to provide an overview of the milieu of techniques used to identify proper orientation of the graft tissue from inking and stamping techniques to tissue modification, use of external instrumentation to aid visualization such as the hand-held slit lamp, chandelier or endo-illuminator probes, and intraoperative anterior segment ocular coherence tomography.