Abstract
Purpose: :
To report the two-year data on corneal endothelial cell loss after Descemet's stripping automated endothelial keratoplasty (DSAEK) with forceps insertion and the Neusidl corneal inserter (NCI)
Methods: :
Two hundred eighty-four eyes underwent Descemet's stripping automated endothelial keratoplasty (DSAEK) using a forceps insertion technique and one hundred and seventy-one eyes underwent the same procedure with the Neusidl corneal inserter (NCI). Preoperative endothelial cell counts on the donor tissue were provided by the eye banks. Postoperative endothelial cell counts were obtained with confocal microscopy (ConfoScan 3 and ConfoScan 4)
Results: :
Mean endothelial cell counts at three months were 1523 cells/mm2 and 1741 cells/mm with forceps and NCI insertion techniques respectively (p-Value 0.00004). Mean endothelial cell counts at 6 months were 1448 cells/mm2 and 1701 cells/mm2 respectively (p-Value 0.00002). At one year, the mean endothelial cell counts were 1369 cells/mm2 and 1678 cells/mm2 respectively (p-Value 0.00001). At two years, the mean endothelial cell counts were 1217 cells/mm2 and 1510 cells/mm2 respectively (p-Value 0.02).Mean endothelial cell loss at three months was 1695 cells/mm2 and 1407 cells/mm with forceps and NCI insertion techniques respectively (p-Value 0.000002). Mean endothelial cell loss at 6 months was 1753 cells/mm2 and 1461 cells/mm2 respectively (p-Value 0.000004). At one year, the mean endothelial cell loss was 1834 cells/mm2 and 1469 cells/mm2 respectively (p-Value 0.000005). At two years, the mean endothelial cell loss was 1982 cells/mm2 and 1625 cells/mm2 respectively (p-Value 0.03).
Conclusions: :
Corneal endothelial cell loss in donor grafts during Descemet's stripping automated endothelial keratoplasty (DSAEK) with the Neusidl corneal inserter (NCI) is less than with traditional forceps insertion. The NCI insertion technique involves less tissue manipulation and appears to avoid crush injury compared to forceps insertion.
Keywords: cornea: endothelium • cell survival • transplantation