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Descemet Stripping Automated Endothelial Keratoplasty in Complex Eyes: Results With a Donor Insertion Device

Khor, Wei-Boon FRCSEd; Teo, Kelvin Y. MBBS; Mehta, Jodhbir S. FRCS; Tan, Donald T-H. FRCS

doi: 10.1097/ICO.0b013e31828321f8
Clinical Science

Purpose: Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with complex anterior segment pathology or previous intraocular surgery is at risk of surgical complications and graft failure. We evaluated the use of the EndoGlide donor insertion device for DSAEK in these complex cases.

Methods: This was a retrospective interventional series of 45 consecutive eyes with endothelial dysfunction and higher risk ocular comorbidities that underwent DSAEK with the EndoGlide. We included eyes with aphakia, glaucoma surgery, prior vitrectomy, anterior chamber intraocular lenses, failed cornea grafts, and primary angle closure glaucoma. Demographic and clinical details, intraoperative and postoperative complications, and postoperative graft clarity, and endothelial cell density (ECD) loss were documented.

Results: The average age was 62 years (range, 16–88 years), and the majority were Chinese (n = 28). The commonest risk factors identified were previous trabeculectomy (n = 13) and failed penetrating keratoplasty (n = 12). Preoperative donor ECD averaged 2790 ± 230 cells per square millimeter and modal graft diameter was 9.0 mm (range, 7.75–9.75 mm). One eye (2.2%) had primary graft failure, and 3 eyes (6.7%) had graft dislocation. Another 3 eyes suffered late graft failure within the first year and 2 were in eyes with an anterior chamber intraocular lenses. At 6 months, the mean ECD was 2363 + 242 cells/mm2 and the mean ECD loss was 17.9% (n = 16). By 12 months, the mean ECD was 2098 + 462 cells/mm2 and the mean ECD loss was 27.0% (n = 20).

Conclusions: Donor insertion with this device can help address inherent intraoperative challenges and minimize endothelial cell damage during DSAEK in complex cases.

*Singapore National Eye Centre, Singapore, Singapore;

Singapore Eye Research Institute, Singapore, Singapore;

Duke-NUS Graduate Medical School, Singapore, Singapore

§Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.

Reprints: Donald T-H. Tan, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, Singapore (e-mail:

Supported by the National Research Foundation–funded Translational & Clinical Research (TCR) Program Grant (NMRC/TCR/002 - SERI/2008—TCR 621/41/2008). D.T-H. Tan and J. S. Mehta, inventors of the EndoGlide, have financial interests in the device (Angiotech; Network Medical Products).

The other authors have no conflicts of interest to declare.

Received October 26, 2012

Accepted December 13, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.