Comparison of Donor Insertion Techniques for Descemet Stripping Automated Endothelial Keratoplasty

Abstract

To evaluate the difference in endothelial cell damage between 2 donor insertion techniques for Descemet stripping automated endothelial keratoplasty (DSAEK). Design: Experimental study and prospective case series. Thirty donor corneas and 10 patients undergoing DSAEK with glide insertion were included. Donor cornea lenticules were prepared and a wet lab DSAEK model established. Donor lenticules were inserted either by a "taco" fold (n= 15) or glide insertion (n = 15). Endothelial cell damage was assessed by scanning electron microscopy (n=20) and trypan blue exclusion (n=10). Endothelial cell count was assessed by specular microscopy in the clinical patients. Results: Endothelial cell viability and scanning electron microscopy demonstrated 2 different patterns of cell damage in either group. Cell viability and scanning electron microscopy showed there was mean cell damage of 9% and 9.2% , respectively, following glide insertion and 32% and 38%, respectively, following the taco-folded insertion (P =.004). The mean (SD) cell loss in the clinical patients following glide insertion was 25.3% (4.3%) at 6 months. Conclusion: Endothelial cell damage was higher in a wet lab model following taco-folded insertion compared with glide insertion. Initial clinical results with glide insertion showed satisfactory endothelial cell loss at 6 months. Clinical Relevance: Folding of the corneal tissue during DSAEK causes more endothelial damage than glide insertion.

Clinical Evaluation of a New Donor Graft Inserter for Descemet’s Stripping Automated Endothelial Keratoplasty

“…10 Mehta et al compared taco-folded insertion and sheet-glide insertion in a laboratory study and concluded that endothelial cell damage was greater in taco-folded insertion (32.0% damage) than sheet-glide insertion (9.0% damage). 13 Li et al investigated endothelial cell damage using the Tan EndoGlide and found a 14.7% damage rate, 26 a result that is comparable with our preliminary laboratory data (10.3% damage by Tan EndoGlide, unpublished data). Collectively, laboratory studies of the Tan EndoGlide are encouraging regarding a lesser degree of endothelial cell damage; however, it is still unclear whether the double coil configuration of the Tan EndoGlide's internal lumen is optimal to protect endothelium.…”

Clinical Evaluation of a New Donor Graft Inserter for Descemet’s Stripping Automated Endothelial Keratoplasty

“…10 Mehta et al compared taco-folded insertion and sheet-glide insertion in a laboratory study and concluded that endothelial cell damage was greater in taco-folded insertion (32.0% damage) than sheet-glide insertion (9.0% damage). 13 Li et al investigated endothelial cell damage using the Tan EndoGlide and found a 14.7% damage rate, 26 a result that is comparable with our preliminary laboratory data (10.3% damage by Tan EndoGlide, unpublished data). Collectively, laboratory studies of the Tan EndoGlide are encouraging regarding a lesser degree of endothelial cell damage; however, it is still unclear whether the double coil configuration of the Tan EndoGlide's internal lumen is optimal to protect endothelium.…”

Endothelial cell counts after Descemet’s stripping automated endothelial keratoplasty versus penetrating keratoplasty in Asian eyes

“……”

Effects of a Novel Push-through Technique Using the Implantable Collamer Lens Injector System for Graft Delivery during Endothelial Keratoplasty

“…This is why endothelial cell damage was greater for donor lenticules delivered by forceps or an injector than non-delivered controls. No use of OVDs might also have contributed to the greater endothelial damage observed in the present study than in previous reports on other injectors [8,24,25]. Nevertheless, our data show that endothelium damage was less for injector-assisted delivery than conventional forceps-assisted delivery, which provides scientific evidence that is useful for clinicians.…”

Clinical Evaluation of a New Donor Graft Inserter for Descemet’s Stripping Automated Endothelial Keratoplasty

“…10 Mehta et al compared taco-folded insertion and sheet-glide insertion in a laboratory study and concluded that endothelial cell damage was greater in taco-folded insertion (32.0% damage) than sheet-glide insertion (9.0% damage). 13 Li et al investigated endothelial cell damage using the Tan EndoGlide and found a 14.7% damage rate, 26 a result that is comparable with our preliminary laboratory data (10.3% damage by Tan EndoGlide, unpublished data). Collectively, laboratory studies of the Tan EndoGlide are encouraging regarding a lesser degree of endothelial cell damage; however, it is still unclear whether the double coil configuration of the Tan EndoGlide's internal lumen is optimal to protect endothelium.…”

Endothelial cell counts after Descemet’s stripping automated endothelial keratoplasty versus penetrating keratoplasty in Asian eyes

“……”

Effects of a Novel Push-through Technique Using the Implantable Collamer Lens Injector System for Graft Delivery during Endothelial Keratoplasty

“…This is why endothelial cell damage was greater for donor lenticules delivered by forceps or an injector than non-delivered controls. No use of OVDs might also have contributed to the greater endothelial damage observed in the present study than in previous reports on other injectors [8,24,25]. Nevertheless, our data show that endothelium damage was less for injector-assisted delivery than conventional forceps-assisted delivery, which provides scientific evidence that is useful for clinicians.…”

Clinical Evaluation of a New Donor Graft Inserter for Descemet’s Stripping Automated Endothelial Keratoplasty

“…10 Mehta et al compared taco-folded insertion and sheet-glide insertion in a laboratory study and concluded that endothelial cell damage was greater in taco-folded insertion (32.0% damage) than sheet-glide insertion (9.0% damage). 13 Li et al investigated endothelial cell damage using the Tan EndoGlide and found a 14.7% damage rate, 26 a result that is comparable with our preliminary laboratory data (10.3% damage by Tan EndoGlide, unpublished data). Collectively, laboratory studies of the Tan EndoGlide are encouraging regarding a lesser degree of endothelial cell damage; however, it is still unclear whether the double coil configuration of the Tan EndoGlide's internal lumen is optimal to protect endothelium.…”

Endothelial cell counts after Descemet’s stripping automated endothelial keratoplasty versus penetrating keratoplasty in Asian eyes

“……”

Effects of a Novel Push-through Technique Using the Implantable Collamer Lens Injector System for Graft Delivery during Endothelial Keratoplasty

“…This is why endothelial cell damage was greater for donor lenticules delivered by forceps or an injector than non-delivered controls. No use of OVDs might also have contributed to the greater endothelial damage observed in the present study than in previous reports on other injectors [8,24,25]. Nevertheless, our data show that endothelium damage was less for injector-assisted delivery than conventional forceps-assisted delivery, which provides scientific evidence that is useful for clinicians.…”