title: Comparison of a donor insertion device to sheets glide in Descemet stripping endothelial keratoplasty: 3-year outcomes.
abstract: OBJECTIVE
  To compare 3-year endothelial cell loss and graft survival following Descemet stripping automated endothelial keratoplasty (DSAEK) using the EndoGlide (AngioTech, Reading, Pennsylvania, USA/Network Medical Products, North Yorkshire, UK) donor insertion device compared to donor insertion using the Sheets glide technique.
  
  
  METHODS
  Retrospective comparative case series.
  
  
  METHODS
  Study involved consecutive patients who underwent DSAEK with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy at a single tertiary center. Clinical data with outcomes and donor and recipient characteristics were obtained from our ongoing prospective cohort from the Singapore Corneal Transplant Study. Main outcome measures were percent endothelial cell loss and graft survival up to 3 years.
  
  
  RESULTS
  Overall percent endothelial cell loss was significantly lower in the EndoGlide group (100 eyes) compared to the Sheets glide group (119 eyes) at 1 year (16.3% ± 16.6% vs 29.5% ± 22.2%, P < .001), 2 years (23.8% ± 17.8% vs 35.7% ± 22.9%, P = .001), and 3 years (29.7% ± 20.9% vs 38.5% ± 24.1%, P = .015) postoperatively. Overall graft survival was greater in the EndoGlide compared to Sheets glide group up to 3 years postoperatively (97.9% vs 86.5%, log-rank P value = .005). In eyes with Fuchs endothelial dystrophy, endothelial cell loss was significantly lower in the EndoGlide group (3-year: 28.2% ± 17.9% vs 43.4% ± 27.1%, P = .032). In eyes with pseudophakic bullous keratopathy, the EndoGlide group had a superior graft survival compared to Sheets glide (log-rank P = .031).
  
  
  CONCLUSIONS
  Endothelial cell loss was lower using a donor insertion device during DSAEK, compared to using the Sheets glide technique for DSAEK, in Asian eyes with Fuchs endothelial dystrophy, and resulted in better graft survival in eyes with pseudophakic bullous keratopathy.
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore.
authors.forename: Marcus
authors.initials: M
authors.lastname: Ang
authors.affiliation: Singapore National Eye Centre, Singapore.
authors.forename: Lasitha
authors.initials: L
authors.lastname: Saroj
authors.affiliation: Singapore Eye Research Institute, Singapore.
authors.forename: Hla-Myint
authors.initials: HM
authors.lastname: Htoon
authors.affiliation: Singapore National Eye Centre, Singapore.
authors.forename: Siehyean
authors.initials: S
authors.lastname: Kiew
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Duke-National University of Singapore Graduate Medical School, Singapore.
authors.forename: Jodhbir S
authors.initials: JS
authors.lastname: Mehta
authors.affiliation: Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Department of Ophthalmology, National University Health System, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore. Electronic address: donald.tan.t.h@snec.com.sg.
authors.forename: Donald
authors.initials: D
authors.lastname: Tan
mesh_terms: D000368:Aged; D001768:Blister / Q000601:surgery*; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000503:physiopathology*; D003886:Descemet Membrane; D057111:Descemet Stripping Endothelial Keratoplasty / Q000295:instrumentation*; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications; D019591:Pseudophakia / Q000601:surgery; D012189:Retrospective Studies; D014019:Tissue Donors