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Jodhbir S. Mehta, MD, FRCS(Edin); Yong Ming Por, MD, FRCS(Edin); Rebekah Poh, BSc; Roger W. Beuerman, PhD; Donald Tan, MD, FRCS(Edin)

Arch Ophthalmol. 2008;126(10):1383-1388.

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.

Author Affiliations: Singapore National Eye Centre (Drs Mehta, Por, and Tan), Singapore Eye Research Institute (Drs Mehta, Beuerman, and Tan and Ms Poh), and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore (Drs Beuerman and Tan), Singapore.