MAR 11, 2011
Loss of endothelial cell density (ECD) during Descemet stripping automated endothelial keratoplasty (DSAEK) can be exacerbated if the surgical technique involves folding of the graft and insertion with forceps, especially in Asian eyes with shallow anterior chambers and high vitreous pressures. In this report, the authors present the surgical technique and early clinical results of the use of the EndoGlide, an insertion device developed specifically to minimize donor endothelial cell injury during DSAEK.
They used the EndoGlide to perform graft insertion during DSAEK in 25 Asian patients (25 eyes) with endothelial dysfunction. The average patient age was 70 and the most common diagnosis was pseudophakic bullous keratopathy (12 eyes).
The prepared graft is transferred onto a preparation base and pulled into the glide capsule with forceps. Drawing the graft into the capsule curls it into a "double-coil" configuration. The assembled EndoGlide is then inserted into the eye and the graft pulled into the anterior chamber with forceps, where it uncoils in the correct orientation with minimal manipulation.
At six month postop the mean ECD was 2586 ± 338 cells/mm2 (preoperative donor ECD was 2957 ± 242 cells/mm2) and mean cell loss was 13.1 percent in 20 eyes. At 12 months, the mean ECD was 2575 ± 289 cells/mm2 and mean cell loss was 15.6 percent in 10 eyes.
Two surgeons completed all surgeries successfully. There was a short learning curve for loading the graft into the EndoGlide and uncoiling it in the recipient eye. No patient experienced graft dislocation or primary iatrogenic graft failure. Intraoperative complications occurred in three eyes, and postoperative complications were minimal.
The authors conclude that the early results of the EndoGlide are promising, especially considering the lack of complications in the immediate postoperative period. Further evaluation of the EndoGlide with more cases and longer follow-up is underway.