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Graft inserters yield similar endothelial cell density after DSAEK
CHICAGO — Two graft insertion devices resulted in similar endothelial cell loss after Descemet’s stripping automated endothelial keratoplasty, according to a study presented here.
“At 6, 12 and 24 months, there was no statistically significant difference,” Benita Lee, MD, said at the American Society of Cataract and Refractive Surgery annual meeting.
The study included 218 eyes with healthy corneas. Donor tissue was inserted through a 5.5-mm incision. Sixty-two patients received donor buttons inserted with non-opposing Ogawa forceps (Moria), while the Busin glide and forceps (Moria) were used to insert tissue in the other 156 eyes.
Non-contact specular microscopy was used to measure postoperative endothelial cell density (ECD) preoperatively and at 6, 12 and 24 months postoperatively.
In the Ogawa forceps group, preoperative ECD was 3,113 cells/mm2. ECD loss was 37.4% at 6 months, 44.7% at 12 months and 48.9% at 24 months.
In the Busin glide group, preoperative ECD was 3,062 cells/mm2. Loss of cell density was 39.8% at 6 months, 43.1% at 12 months and 46.3% at 24 months, Dr. Lee said.
At 6, 12 and 24 months, results showed statistically insignificant differences in endothelial cell loss between the two groups, she said.
- Disclosure: Dr. Lee has no relevant financial disclosures.
Perspective
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This study shows the approximate endothelial cell loss with the standard taco-folding technique and one of the earlier specific inserter devices, the Busin glide (Moria). Although the reported endothelial cell loss with both techniques is similar, there are other published studies which show that the Busin device does have lower cell loss than standard taco techniques. And the published literature shows that taco folding results in endothelial cell loss at 1 year to be in the range of 35% to 40%, while the Busin glide may result in slightly lower cell loss rates of 25% to 30%. One recently published UK study in which the Busin glide was compared with the EndoGlide (Network Medical), a newer inserter device, showed that after correcting for an additional 8% cell loss from the form of tissue preservation (organ culture), cell loss with the Busin glide at 6 months was 39%, identical to this study. The study, however, also showed endothelial cell loss with the EndoGlide to be lower, at 18% at 6 months. It is therefore hoped that some of the newer inserter devices, such as the EndoGlide and the EndoSerter (Ocular Systems Inc.), may further result in reduced endothelial cell loss in DSAEK.
This study highlights the importance of DSAEK surgeons paying attention to endothelial cell rates in DSAEK patients and selecting the appropriate surgical techniques to improve outcomes. This study also highlights the importance of reporting and publishing clinical results of the newer DSAEK surgical devices currently available, so as to enable surgeons to make an informed choice as to the techniques that may lead to better outcomes in their clinical practice.