title: Descemet Membrane Endothelial Keratoplasty: Preliminary Results of a Donor Insertion Pull-through Technique Using a Donor Mat Device.
abstract: OBJECTIVE
  To evaluate a novel technique of Descemet membrane endothelial keratoplasty (DMEK) donor insertion using the EndoGlide pull-through device.
  
  
  METHODS
  Prospective, interventional cases series.
  
  
  METHODS
  We performed DMEK using the EndoGlide technique with a protoype donor carrier device (Descemet Mat, or D-Mat) in 30 patients by a single surgeon (including learning curve). Clinical data and donor and recipient characteristics were tracked from our prospective Singapore Corneal Transplant Registry. Main outcome measures were intraoperative complications and the incidence of postoperative graft detachment and primary graft failures within 3 months from surgery.
  
  
  RESULTS
  In our preliminary study of 30 eyes in 30 patients (73% female, mean age 64.5 ± 8.3 years), we observed 3 cases (10%) of partial donor detachment requiring rebubbling and 1 (3%) primary donor failure. Twenty of 30 eyes (66.7%) achieved ≥20/25 3-month best spectacle-corrected visual acuity. Six-month endothelial cell loss reduced from 65% ± 13% to 48% ± 11% (P = .02) comparing the first and last 15 cases. With the exception of 1 case with excessive fibrin formation, we did not experience any further intraoperative complications related to donor tissue insertion, incomplete tissue unfolding, donor tissue malposition, or incorrect orientation.
  
  
  CONCLUSIONS
  Our study suggests that the described technique allows for donor control and insertion in the correct orientation with the endothelium facing down. Further studies are required to confirm if this DMEK donor insertion technique can lead to reduced endothelial cell loss and better graft survival.
authors: Singapore National Eye Centre, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore; Department of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
authors: Marcus
authors: M
authors: Ang
authors: Singapore National Eye Centre, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore; Department of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
authors: Jodhbir S
authors: JS
authors: Mehta
authors: Menicon Co Ltd, Singapore, Singapore.
authors: Stephen D
authors: SD
authors: Newman
authors: Singapore Eye Research Institute, Singapore, Singapore; Department of Ophthalmology, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Sang Beom
authors: SB
authors: Han
authors: Singapore National Eye Centre, Singapore, Singapore.
authors: Jean
authors: J
authors: Chai
authors: Singapore National Eye Centre, Singapore, Singapore; Singapore Eye Research Institute, Singapore, Singapore; Department of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore. Electronic address: donald.tan.t.h@singhealth.com.sg.
authors: Donald
authors: D
authors: Tan
mesh_terms: D057111:Descemet Stripping Endothelial Keratoplasty / Q000295:instrumentation*; D004728:Endothelium, Corneal / Q000637:transplantation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000175:diagnosis / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D014019:Tissue Donors; D066027:Transplant Recipients