Comparison of donor insertion techniques for descemet stripping automated endothelial keratoplasty

Arch Ophthalmol. 2008 Oct;126(10):1383-8. doi: 10.1001/archopht.126.10.1383.


Objective: To evaluate the difference in endothelial cell damage between 2 donor insertion techniques for Descemet stripping automated endothelial keratoplasty (DSAEK).

Design: Experimental study and prospective case series. Thirty donor corneas and 10 patients undergoing DSAEK with glide insertion were included. Donor cornea lenticules were prepared and a wet lab DSAEK model established. Donor lenticules were inserted either by a "taco" fold (n = 15) or glide insertion (n = 15). Endothelial cell damage was assessed by scanning electron microscopy (n = 20) and trypan blue exclusion (n = 10). Endothelial cell count was assessed by specular microscopy in the clinical patients.

Results: Endothelial cell viability and scanning electron microscopy demonstrated 2 different patterns of cell damage in either group. Cell viability and scanning electron microscopy showed there was mean cell damage of 9% and 9.2% , respectively, following glide insertion and 32% and 38%, respectively, following the taco-folded insertion (P = .004). The mean (SD) cell loss in the clinical patients following glide insertion was 25.3% (4.3%) at 6 months.

Conclusion: Endothelial cell damage was higher in a wet lab model following taco-folded insertion compared with glide insertion. Initial clinical results with glide insertion showed satisfactory endothelial cell loss at 6 months. Clinical Relevance Folding of the corneal tissue during DSAEK causes more endothelial damage than glide insertion.

Publication types

  • Comparative Study

MeSH terms

  • Cell Survival / physiology
  • Corneal Diseases / pathology
  • Corneal Diseases / surgery
  • Corneal Topography
  • Corneal Transplantation / methods*
  • Corneal Transplantation / pathology
  • Descemet Membrane / surgery*
  • Endothelial Cells / pathology
  • Endothelial Cells / ultrastructure
  • Endothelium, Corneal / cytology
  • Endothelium, Corneal / pathology*
  • Endothelium, Corneal / transplantation*
  • Eye Banks
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Microscopy, Confocal
  • Models, Biological
  • Photomicrography
  • Probability
  • Risk Assessment
  • Statistics, Nonparametric
  • Tissue Donors
  • Treatment Outcome
  • Visual Acuity