Descemet stripping automated endothelial keratoplasty with a graft insertion device: surgical technique and early clinical results

Purpose: To present the surgical technique and the early clinical results of the EndoGlide, a graft insertion device for use during Descemet stripping automated endothelial keratoplasty (DSAEK).

Design: Prospective interventional case series.

Patients: Graft insertion with the EndoGlide was performed in 25 eyes of Asian patients with endothelial dysfunction suitable for DSAEK. Demographic and clinical details, best-corrected visual acuity, postoperative complications, and endothelial cell density (ECD) loss were documented.

Surgical technique: 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 inserted into the eye, and the graft is pulled into the anterior chamber with forceps, where it uncoils in the correct orientation with minimal manipulation.

Results: Average age was 70 years (range 28-91) and the commonest diagnosis was pseudophakic bullous keratopathy (12 eyes). Preoperative donor ECD was 2957 ± 242 cells/mm(2), median graft diameter was 8.75 mm, and all surgeries were completed successfully by 2 surgeons. There was a short learning curve in loading of the graft into the EndoGlide and in uncoiling the graft in the recipient eye. No patient had graft dislocation or primary iatrogenic graft failure. At 6 months, the mean ECD was 2586 ± 338 cells/mm(2) and mean cell loss was 13.1% in 20 eyes. At 12 months, the mean ECD was 2575 ± 289 cells/mm(2) and mean cell loss was 15.6% in 10 eyes.

Conclusions: Graft insertion with the EndoGlide is safe in DSAEK, with a short learning curve and a low endothelial cell loss at 6 and 12 months.