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DSAEK with novel insertion technique yields less cell loss than conventional procedure

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Inserting an asymmetrically folded donor graft in a 40/60 underfold instead of a 60/40 overfold is an easy technique that can reduce trauma to the exposed peripheral endothelium during Descemet's stripping automated endothelial keratoplasty, a study found.

Edwin S. Chen, MD, and colleagues used the new 40/60 underfold technique to insert donor grafts in 36 eyes and compared resulting endothelial cell damage with cell loss observed in 112 eyes that received donor grafts using the conventional 60/40 overfold insertion technique.

During the 40/60 underfold procedure, donor tissue is grasped with the insertion forceps through a prone hand position. The hand is then rotated clockwise to the supine position, which places the 60% side of the fold in the anterior position for insertion into the anterior chamber, the authors said.

At 6 months, eyes that received donor grafts using the conventional 60/40 overfold technique experienced a 36% loss in endothelial cell density.

However, eyes that received grafts using the new 40/60 underfold technique experienced a 26% endothelial cell loss (P = .001), according to the study, published in the September issue of Cornea.