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Jeanine Baqai, Vanee Virasch, Jonathan B. Rubenstein; Descemet’s Stripping Endothelial Keratoplasty with a Forceps Insertion versus a Donor Corneal Inserter. Invest. Ophthalmol. Vis. Sci. 2012;53(14):36.
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To compare outcomes and complications of Descemet’s Stripping Endothelial Keratoplasty (DSEK) using forceps insertion versus a donor corneal inserter
A retrospective review was performed on 106 consecutive procedures performed on 94 eyes by a single surgeon on 71 patients at a tertiary care center. Certain patients were excluded from the study including those who had undergone previous PK or who had end stage glaucoma, optic neuropathy, or macular disease. Visual outcomes, cornea edema, corneal haze, and complications were compared between patients undergoing lenticule insertion with forceps versus the donor corneal inserter.
71 patients with either Fuchs’ Dystrophy (51 patients) or Pseudophakic Bullous Keratopathy (20 patients) were included in the study. Forceps insertion was used for 84 procedures and the donor corneal inserter was used for 22 procedures. The differences in average post-operative visual acuity among the 2 groups undergoing DSEK were not statistically significant. The average post-operative month 1 best corrected visual acuity (BCVA) was 20/59 for patients undergoing forceps insertion and 20/71 for patients undergoing insertion with the donor corneal inserter (p=0.51). The average post-operative month 12 BCVA was 20/46 for patients undergoing forceps insertion and 20/44 for patients undergoing insertion with the donor corneal inserter (p=0.52). Rebubbling of the graft was needed in 15% of the forceps group and 10% of the donor corneal inserter group, which was statistically significant (p=0.049). The incidence of corneal haze was 12% in the forceps group and 10% in the donor corneal inserter group which was not statistically significant. Residual corneal edema occurred in 8% of the forceps group and 10% of the donor corneal inserter group which was not statistically significant.
DSEK allows for a rapid visual recovery and more predictable refractive outcomes. There was a statistically significant difference in the rate of rebubbling, with a lower need for rebubbling when using the donor corneal inserter. There does not appear to be a correlation between instrumentation used and visual outcome, corneal edema, or corneal haze.
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