A comparison of Small Incision Graft Insertion Methods
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Transcript 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
Descemet’s Stripping Endothelial
Keratoplasty DSEK has been established as
the treatment of choice in the treatment of
Fuchs’ Dystrophy and Bullous Keratopathy
Current graft insertion techniques have
been shown to decrease endothelial
integrity of the donor cornea, reducing the
efficacy of the transplant.
Current Methods of DSEK delivery
3mm Incision
Injectors- Endosaver, NCI, Endoshield
Trifold
Pull through
Folded
Unfolded
5mm Incision
Bifold
Busin glide
Pull through
Methods
An interventional case series analysis of 213 eyes
undergoing DSAEK for Fuchs' endothelial dystrophy
and bullous keratopathy.
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.
Trifold
Supinate
Endo
S
S
Endothelial
side up
Stroma
Forceps
on stroma
side
S
Trifold
Endosaver
Injector
(See Video)
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.
6 Month Visual Acuity
Eyes without Ocular Co-morbidities
100%
98%
100%
Exclusion Criteria
Glaucoma
8
ION
1
Macular Edema
8
Macular
Ischemia
1
50%
Trauma
1
40%
AMD
13
30%
Corneal Scar
6
20%
CRAO
1
10%
Vit. Hemorrhage
1
90%
80%
72%
70%
70%
60%
40
0%
Trifold
20/40 or better
Endosaver
20/60 or better
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.