Endothelial Cell Loss During DSAEK With Traditional Forceps Insertion And Neusidl Corneal Inserter

Abstract

Purpose: : To evaluate corneal endothelial cell loss during Descemet's stripping automated endothelial keratoplasty (DSAEK) with traditional forceps insertion and the Neusidl corneal inserter (NCI).

Methods: : Two hundred eighty-four eyes underwent Descemet's stripping automated endothelial keratoplasty (DSAEK) using a traditional forceps insertion technique and one hundred twenty-four 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 3 months were 1523 cells/mm² and 1747 cells/mm² with traditional and NCI insertion techniques respectively (p=0.0002). Mean endothelial cell counts at 6 months were 1448 cells/mm² and 1675 cells/mm² respectively (p=0.002). At one year, the endothelial cell counts were 1369 cells/mm² and 1595 cells/ mm² respectively (p=0.03).Mean endothelial cell loss at three months was 1685 cells/mm² with the traditional forceps technique and 1395 cells/mm² with the NCI (p=0.0001).

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 endothelial cell counts in the NCI group remain higher than in the traditional group throughout the first year.

Keywords: cornea: endothelium • transplantation • cell survival