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New Graft Inserter for Descemet Stripping Automated Endothelial Keratoplasty

Toyama, Taku MD; Honda, Norihiko MD, PhD; Usui, Tomohiko MD, PhD; Amano, Shiro MD, PhD

doi: 10.1097/ICO.0000000000000073

Purpose: The aim of this study was to introduce a newly developed graft inserter for Descemet stripping automated endothelial keratoplasty, which can be readily used with 1 hand, and to examine endothelial cell loss (ECL) after graft insertion using this new inserter in an ex vivo rabbit model.

Methods: Rabbit corneal grafts (∼150 μm) were prepared by using a femtosecond laser. The grafts were inserted into an artificial anterior chamber by the pull-through technique using a Busin glide or the push-out technique using our new inserter. ECL was evaluated by means of trypan blue and alizarin red S staining. Grafts that were not injected served as a control group.

Results: The mean percentages of ECL area in the control, Busin glide, and new inserter groups were 18.7 ± 1.79%, 25.4 ± 2.32%, and 24.7 ± 1.56%, respectively. The mean percentages of the ECL area in both the Busin glide group and new inserter groups were significantly greater than that in the control group (P = 0.001). There was no statistically significant difference between the Busin glide group and the new inserter group.

Conclusions: Our new inserter may provide a favorable option for donor tissue insertion in Descemet stripping automated endothelial keratoplasty procedures.

*Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan; and

Honda Eye Clinic, Kanagawa, Japan.

Reprints: Shiro Amano, Department of Ophthalmology, University of Tokyo School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan (e-mail:

Supported by a Grant-in-Aid for Scientific Research (B) (24390394) from the Ministry of Health, Labor, and Welfare of Japan.

The authors have no funding or conflicts of interest to disclose.

Received September 07, 2013

Accepted December 19, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.