Novel DSAEK technique may reduce graft injury, study suggests

A novel cartridge-based technique for inserting an endothelial graft during Descemet stripping automated endothelial keratoplasty appears to cause considerably less damage to the graft endothelium compared with forceps insertion, a laboratory study by researchers in North Carolina and Wisconsin suggests.

Anthony N. Kuo, MD, and colleagues compared graft trauma after performing Descemet stripping automated endothelial keratoplasty (DSAEK) on 10 pairs of human donor corneas. For each pair of donor corneas, the endothelial grafts for left eyes were inserted into 3-mm clear corneal wounds using single-fold delivery. For right eyes, a cartridge-based "rolling" technique was used, which involves a 23-gauge needle cystitome and an IOL cartridge, according to the study.

Investigators evaluated graft trauma between the two insertion techniques by staining grafts with 0.25% trypan blue and 0.2% alizarin red.

After successful insertion, the average proportion of graft endothelial trauma from forceps delivery in the ex vivo model was significantly higher than from the cartridge delivery technique. After insertion, graft injury averaged 26.02% for the forceps technique and 9.85% for the cartridge-based technique, the authors reported.

"Within each pair, the median difference between the two methods was +13%, representing more endothelial injury with the forceps method. This difference was statistically significant (P = .006)," the authors said.

Subsequently, surgeons performed DSAEK on one patient using the cartridge-based method.

At 5 months follow-up, the patient showed improved visual acuity and a clear graft.

Central corneal pachymetry totaled 639 µm and the central endothelial cell count totaled 2,130 cells/mm², according to the study.

"This represented a 21% decline in donor endothelial cell count from preoperative levels," the authors said.

The study is published in the January issue of American Journal of Ophthalmology.