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M. O. Price, K. Fairchild, F. W. Price, Jr.; Effect of 3 Different Graft Insertion Methods on 1-Year Endothelial Cell Loss After DSAEK. Invest. Ophthalmol. Vis. Sci. 2009;50(13):613.
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To compare 1-year endothelial cell loss using 3 methods to insert the donor graft in Descemet's stripping automated endothelial keratoplasty (DSAEK)
This was a single-center, interventional, retrospective study of DSAEK cases performed between January and December 2007 by a single surgeon. During the study, 3 methods of donor graft insertion were used concurrently in different operating rooms of the surgery center. One method consisted of folding the donor graft in a 60/40 taco configuration with the endothelial side inward and inserting it with single-point fixation forceps that had relatively sharp tips. The second method consisted of folding the graft in a similar manner and inserting it with rounded-tip single-point fixation forceps which had stop that kept the tips 150-microns apart to help minimize tissue compression. The third method consisted of pulling the graft through a funnel glide which curled the graft into a cylindrical shape for insertion. A 5-mm incision width was used in all cases. Endothelial cell density was assessed 1 year after DSAEK using specular and confocal microscopy. The 1-year post-operative cell density was compared with the donor cell density reported by the provider eye bank to determine 1-year cell loss. Analysis of variance was used to compare the cell loss with the 3 insertion methods.
One-year endothelial cell density was assessed in 150 eyes. The 3 insertion groups had comparable patient demographics, including age (p=0.67), sex (p=.18), and reason for transplant (p=.19). The mean 1-year endothelial cell loss was 27 ± 19% when the graft was pulled into the eye through a funnel glide, 31 ± 19% with the rounded-tip single-point fixation forceps, and 37 ± 21% with the sharper tipped single-point fixation forceps. The 1-year endothelial cell loss in the 3 groups differed by a statistically significant amount (p=0.04).
Curling the DSAEK graft into a cylindrical shape for insertion through a 5-mm incision caused less endothelial cell loss than folding the graft for insertion with either of 2 types of single-point fixation forceps. This suggests that improved graft insertion techniques can successfully reduce endothelial cell loss, which may help improve graft longevity.
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