title: Effects of a novel push-through technique using the implantable collamer lens injector system for graft delivery during endothelial keratoplasty.
abstract: OBJECTIVE
  To investigate effects of a new push-through insertion method for donor lenticules using an injector system on endothelial viability ex vivo and in a clinical case series of endothelial keratoplasty.
  
  
  METHODS
  An ex vivo delivery model was used with porcine corneoscleral rims. We compared the endothelial viability in a new push-through insertion method using the Visian Implantable Collamer Lens (ICL) injector versus that of standard forceps-assisted insertion for lenticule delivery. Twenty porcine corneal lenticules were divided into four groups by insertion method and wound size. Vital dye staining was performed and devitalized areas were semi-quantitatively assessed by digital imaging. In the clinical case series, Descemet's stripping endothelial keratoplasty (DSEK) using the push-through method was performed in seven patients and endothelial outcome was determined six months postoperatively.
  
  
  RESULTS
  Mean devitalized areas for the push-through method were significantly lower than for forceps-assisted insertion through 3.2 mm incision (23.99 ± 2.17% vs. 50.48 ± 5.07%, p = 0.009) in the ex vivo model. Average endothelial cell counts of donor tissues of patients who underwent DSEK were 26.4% lower six months postoperatively.
  
  
  CONCLUSIONS
  Push-through delivery of donor lenticules using the Visian ICL injector system appears to be less harmful to endothelial cells than conventional forceps-assisted delivery.
authors.affiliation: Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea.
authors.forename: Sug Jae
authors.initials: SJ
authors.lastname: Kang
authors.forename: Myung Hun
authors.initials: MH
authors.lastname: Kim
authors.forename: Mee Kum
authors.initials: MK
authors.lastname: Kim
authors.forename: Won Ryang
authors.initials: WR
authors.lastname: Wee
authors.forename: Jin Hak
authors.initials: JH
authors.lastname: Lee
authors.forename: Eui Sang
authors.initials: ES
authors.lastname: Chung
mesh_terms: D000818:Animals; D055954:Corneal Endothelial Cell Loss / Q000517:prevention & control*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D019654:Lens Implantation, Intraocular / Q000295:instrumentation* / Q000379:methods*; D007910:Lenses, Intraocular; D023421:Models, Animal; D011183:Postoperative Complications / Q000517:prevention & control*; D011474:Prosthesis Design; D013552:Swine
keywords: Descemet's stripping endothelial keratoplasty; Endothelial viability; Visian implantable collamer lens injector system
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