title: Descemet stripping automated endothelial keratoplasty with a donor insertion device: clinical results and complications in 100 eyes.
abstract: OBJECTIVE
  To study the clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with the EndoGlide donor insertion device.
  
  
  METHODS
  Retrospective interventional case series.
  
  
  METHODS
  We included 100 eyes that underwent DSAEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy (PBK) at a single institution. Eyes with anterior segment pathology or previous intraocular surgery (except for uncomplicated cataract surgery) were excluded. Preoperative data included visual acuity and donor endothelial cell density by specular microscopy. The main outcome measures were postoperative best spectacle-corrected visual acuity (BSCVA) and endothelial cell loss at 3, 6, and 12 months.
  
  
  RESULTS
  There were 59 eyes with Fuchs dystrophy and 41 eyes with PBK. In eyes without vision-limiting pathology, the median postoperative BSCVA was consistently 20/40 (range 20/20-20/400) at 3 months (n = 61 eyes), 6 months (n = 55 eyes), and 12 months (n = 48 eyes). Endothelial cell loss was 13.7% at 3 months (n = 57), 13.5% at 6 months (n = 61), and 14.9% at 12 months (n = 53). Primary graft failure occurred in 1 eye, attributable to incorrect use of the insertion device. Two eyes with complete donor dislocation were rebubbled successfully. The most common complication was glaucoma/ocular hypertension in 29 eyes (34.1%) without prior glaucoma and treatment escalation in 6 eyes (40.0%) with prior glaucoma. Of the 78 eyes with 12 months follow-up, 2 (2.6%) developed endothelial rejection, and 1 (1.3%) subsequently failed.
  
  
  CONCLUSIONS
  The use of this donor insertion device during DSAEK demonstrates good outcomes and potentially low endothelial cell loss at up to 12 months after surgery.
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore.
authors.forename: Wei-Boon
authors.initials: WB
authors.lastname: Khor
authors.forename: Sang-Beom
authors.initials: SB
authors.lastname: Han
authors.forename: Jodhbir S
authors.initials: JS
authors.lastname: Mehta
authors.forename: Donald T H
authors.initials: DT
authors.lastname: Tan
mesh_terms: D000368:Aged; D002452:Cell Count; D003317:Corneal Dystrophies, Hereditary / Q000503:physiopathology / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis / Q000209:etiology; D057111:Descemet Stripping Endothelial Keratoplasty / Q000295:instrumentation*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D009885:Ophthalmology / Q000295:instrumentation; D011183:Postoperative Complications; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology