Busin Guide vs Forceps for the Insertion of the Donor Lenticule in Descemet Stripping Automated Endothelial Keratoplasty

Am J Ophthalmol. 2009 Feb;147(2):220-226.e1. doi: 10.1016/j.ajo.2008.08.029. Epub 2008 Oct 18.


Purpose: To compare two insertion methods in Descemet stripping automated endothelial keratoplasty (DSAEK): Busin guide-assisted vs Forceps-assisted insertion of the corneal lenticule graft.

Design: Prospective, consecutive, comparative, nonrandomized study.

Methods: setting: Cornea clinic at the Toronto Western Hospital. study population: Sixty-three eyes of 63 consecutive patients were included. All patients underwent DSAEK for Fuchs endothelial dystrophy, pseudophakic bullous keratopathy, aphakic bullous keratopathy, failed graft, or iridocorneo endothelial syndrome. Twenty-six consecutive donor discs were inserted with the Busin guide and 37 consecutive eyes underwent forceps assisted insertion of the donor. main outcome measures: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, corneal endothelial cell loss, and postoperative complications.

Results: Busin guide-assisted DSAEK group had significantly worse UCVA and lower donor endothelial cell counts preoperatively. No significant differences were noted in the intraoperative or postoperative complications. Six months following surgery, BCVA was not significantly different between groups: 20/37 in the Busin guide-assisted DASEK group vs 20/42 in the Forceps-assisted group (P = .39). Mean spherical equivalent was -0.02 diopters (D) and 0.82 D (P = .06), and mean refractive cylinder was 2.2 D and 1.31 D (P = .0006), respectively. Endothelial cell loss was significantly lower in the Busin guide-assisted DASEK group: 25% loss vs 34.3% loss in the Forceps-assisted DSAEK group. (P = .04).

Conclusions: Although visual outcomes were not different between the groups studied, Busin guide-assisted DSAEK resulted in lower percentage of endothelial cell loss compared with forceps insertion, six months following surgery.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Cell Count
  • Corneal Diseases / physiopathology
  • Corneal Diseases / surgery*
  • Corneal Transplantation / instrumentation
  • Corneal Transplantation / methods*
  • Descemet Membrane / surgery*
  • Endothelium, Corneal / pathology
  • Endothelium, Corneal / transplantation*
  • Female
  • Humans
  • Intraoperative Complications
  • Male
  • Ophthalmology / instrumentation*
  • Postoperative Complications
  • Prospective Studies
  • Refraction, Ocular / physiology
  • Tissue Donors
  • Visual Acuity / physiology