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DSAEK Evolution: A comparison of Small Incision Graft Insertion Methods

DSAEK Evolution: A comparison of Small Incision Graft Insertion Methods. J. Brian Foster, MD No Financial Disclosures Keith Walter, MD Patent for Endosaver , consultant for Allergan , Alcon, Oculus, Inspire. Introduction.

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DSAEK Evolution: A comparison of Small Incision Graft Insertion Methods

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  1. DSAEK Evolution: A comparison of Small Incision Graft Insertion Methods J. Brian Foster, MD No Financial Disclosures Keith Walter, MD Patent for Endosaver, consultant for Allergan, Alcon, Oculus, Inspire

  2. Introduction • Descemet’s Stripping Endothelial Keratoplasty DSEK has been established as the treatment of choice in the treatment of Fuchs’ Dystrophy and BullousKeratopathy • Current graft insertion techniques have been shown to decrease endothelial integrity of the donor cornea, reducing the efficacy of the transplant.

  3. Current Methods of DSEK delivery • 3mm Incision • Injectors- Endosaver, NCI, Endoshield • Trifold • Pull through • Folded • Unfolded • 5mm Incision • Bifold • Busin glide • Pull through

  4. Methods • An interventional case series analysis of 213 eyes undergoing DSAEK for Fuchs' endothelial dystrophy and bullouskeratopathy. • 40 eyes met exclusion criteria of prior penetrating keratoplasty, incisional glaucoma, or retinal surgery. • 105 eyes were performed with a small-incision forceps "trifold" insertion technique and 68 eyes were performed with a no-fold DSAEK graft injector. • We noted pre and post-operative visual acuity at 3 and 6 months, pre and post-operative endothelial cell counts, and complications, including graft detachment, failure, and rejection rates.  

  5. Endo Stroma Trifold Supinate Forceps on stroma side Endothelial side up

  6. Trifold

  7. Endosaver Injector (See Video)

  8. Results • Average post-operative endothelial cell loss at 6 months was 27.7% (n=27) for the injector group and 54.8% (n=51) for the forceps group. • There were three post-op graft dislocations in the injector group (4.4%) and 29 (28%) for the forceps group. • There were 5 graft failures in the forcep group and none in the injector group. • There were no cases of graft rejection.

  9. Conclusions • Preservation of donor endothelium is important for long-term graft survival and speed of visual rehabilitation after DSAEK. • Our injector device permits a no-fold graft insertion through a 4mm incision with a lower graft dislocation rate and endothelial cell loss than a small incision forcep technique.

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