Skip Navigation LinksHome > October 2007 - Volume 26 - Issue 9 > Descemet-Stripping Automated Endothelial Keratoplasty: Effec...
Cornea:
doi: 10.1097/ICO.0b013e318142bdde
Clinical Science

Descemet-Stripping Automated Endothelial Keratoplasty: Effect of Inserting Forceps on DSAEK Donor Tissue Viability by Using an In Vitro Delivery Model and Vital Dye Assay

Ide, Takeshi MD, PhD; Yoo, Sonia H MD; Goldman, James M MD; Perez, Victor MD, PhD; O'Brien, Terrence P MD

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Abstract

Purpose: To qualitatively assess the extent and pattern of endothelial trauma on corneal donor Descemet-stripping automated endothelial keratoplasty (DSAEK) buttons resulting from DSAEK insertion forceps.

Methods: An in vitro model was used with corneoscleral rims, DSAEK quality corneal donor tissue, and DSAEK insertion forceps. After insertion of the donor button through the corneoscleral rim, a vital dye assay was used to identify devitalized and necrotic endothelial cells (with alizarin red S and typan blue).

Results: Corneal buttons evaluated with the forceps delivery model showed that, for each arm of the forceps, there were 2 parallel bands of purple/red staining. In addition, orthogonal wrinkles of scattered blue devitalized nuclei were seen in a parallel arrangement.

Conclusions: The DSAEK insertion forceps resulted in a reproducible pattern of endothelial damage. A thorough understanding of iatrogenic endothelial trauma could result in improved forceps design and perhaps help mitigate the high rate of donor dislocation and graft failure in the future.

© 2007 Lippincott Williams & Wilkins, Inc.

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