Comparison of donor insertion techniques for Descemet stripping automated endothelial keratoplasty

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 tab 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 (it = 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.