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DSAEK Evolution: 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. - PowerPoint PPT Presentation
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DSAEK Evolution: A comparison of Small Incision Graft Insertion Methods
J. Brian Foster, MD No Financial DisclosuresKeith Walter, MD Patent for Endosaver, consultant for Allergan, Alcon, Oculus, Inspire
IntroductionDescemet’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 delivery3mm Incision
Injectors- Endosaver, NCI, EndoshieldTrifoldPull through
FoldedUnfolded
5mm IncisionBifoldBusin glidePull through
MethodsAn 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.
SEndothelial side up
Forceps on stroma
side
Endo
Stroma
SupinateTrifold
Trifold
Endosaver Injector
(See Video)
ResultsAverage 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.
Trifold Endosaver0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
72% 70%
98% 100%
6 Month Visual AcuityEyes without Ocular Co-
morbidities
20/40 or better 20/60 or better
Exclusion CriteriaGlaucoma 8
ION 1
Macular Edema 8Macular Ischemia 1
Trauma 1
AMD 13
Corneal Scar 6
CRAO 1
Vit. Hemorrhage 1
40
ConclusionsPreservation 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.