This retrospective study found that using a donor insertion device resulted in less endothelial cell loss and better graft survival than the pull-through Sheets glide technique up to three years after Descemet stripping automated endothelial keratoplasty (DSAEK).
This study is important as there have been few head-to-head studies comparing DSAEK techniques. While the EndoGlide is a more expensive instrument, this study suggests its use may be associated with better long-term outcomes.
The study’s authors compared the single-center outcomes of DSAEK using the EndoGlide donor insertion device (AngioTech) with the Sheets glide insertion technique in 219 consecutive Asian patients with Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy.
Endothelial cell loss was significantly lower in the EndoGlide group at one, two and three years postop. For example, at one year, the percent loss in the EndoGlide group was 16% compared to 30% in the sheets glide group. Overall graft survival at three years was also better in the EndoGlide group (98% vs. 87%, P = 0.005).
The EndoGlide also yielded less endothelial cell loss at three years in eyes with Fuchs’ endothelial dystrophy (28.2% vs. 43.4%) and superior three-year graft survival in eyes with pseudophakic bullous Keratopathy.
The authors write that these results have significant clinical implications, suggesting the benefit of using a donor insertion device to reduce initial endothelial cell damage and thus lower endothelial cell loss in the long term.
However, they also note key differences in this study cohort compared to other study populations: this predominantly Asian population had eyes with relatively shallow anterior chambers, and there was a higher proportion of eyes with pseudophakic bullous keratopathy compared to the other studies with long-term DSAEK results.
They conclude that further studies are needed to determine if this lower endothelial cell loss is maintained with time and to evaluate the impact of this device on even longer-term graft survival.