Comparison of donor insertion techniques for descemet stripping automated endothelial keratoplasty.
OBJECTIVE
To evaluate the difference in endothelial cell damage between 2 donor insertion techniques for Descemet stripping automated endothelial keratoplasty (DSAEK).


METHODS
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.


CONCLUSIONS
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.
Mehta
Jodhbir S
JS
Singapore National Eye Centre, Singapore. jodmehta@gmail.com
Por
Yong Ming
YM
Poh
Rebekah
R
Beuerman
Roger W
RW
Tan
Donald
D
D002470:Cell Survival / Q000502:physiology; D003316:Corneal Diseases / Q000473:pathology / Q000601:surgery; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000379:methods* / Q000473:pathology; D003886:Descemet Membrane / Q000601:surgery*; D042783:Endothelial Cells / Q000473:pathology / Q000648:ultrastructure; D004728:Endothelium, Corneal / Q000166:cytology / Q000473:pathology* / Q000637:transplantation*; D005125:Eye Banks; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D008954:Models, Biological; D010784:Photomicrography; D011336:Probability; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D014019:Tissue Donors; D016896:Treatment Outcome; D014792:Visual Acuity