Descemet-stripping automated endothelial keratoplasty: effect of inserting forceps on DSAEK donor tissue viability by using an in vitro delivery model and vital dye assay.
OBJECTIVE
To qualitatively assess the extent and pattern of endothelial trauma on corneal donor Descemet-stripping automated endothelial keratoplasty (DSAEK) buttons resulting from DSAEK insertion forceps.


METHODS
An in vitro model was used with corneoscleral rims, DSAEK quality corneal donor tissue, and DSAEK insertion forceps. After insertion of the donor button through the corneoscleral rim, a vital dye assay was used to identify devitalized and necrotic endothelial cells (with alizarin red S and typan blue).


RESULTS
Corneal buttons evaluated with the forceps delivery model showed that, for each arm of the forceps, there were 2 parallel bands of purple/red staining. In addition, orthogonal wrinkles of scattered blue devitalized nuclei were seen in a parallel arrangement.


CONCLUSIONS
The DSAEK insertion forceps resulted in a reproducible pattern of endothelial damage. A thorough understanding of iatrogenic endothelial trauma could result in improved forceps design and perhaps help mitigate the high rate of donor dislocation and graft failure in the future.
Ide
Takeshi
T
Bascom Palmer Eye Institute, Miami, FL 33136, USA.
Yoo
Sonia H
SH
Goldman
James M
JM
Perez
Victor
V
O'Brien
Terrence P
TP
D000880:Anthraquinones; D002452:Cell Count; D002470:Cell Survival; D004396:Coloring Agents; D016039:Corneal Transplantation / Q000295:instrumentation / Q000473:pathology*; D003886:Descemet Membrane / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology* / Q000637:transplantation*; D006801:Humans; D007431:Intraoperative Complications; D008954:Models, Biological; D013194:Staining and Labeling / Q000379:methods; D014019:Tissue Donors; D014343:Trypan Blue
D000880:Anthraquinones; D004396:Coloring Agents; C004468:Alizarin Red S; D014343:Trypan Blue