Author(s): Mehta JS, Por YM, Poh R, Beuerman RW, Tan D
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Abstract OBJECTIVE: To evaluate the difference in endothelial cell damage between 2 donor insertion techniques for Descemet stripping automated endothelial keratoplasty (DSAEK). DESIGN: 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. CONCLUSION: 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.
This article was published in Arch Ophthalmol
and referenced in Anatomy & Physiology: Current Research