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H. yokogawa, A. Kobayashi, K. Sugiyama; Clinical Outcomes With the Tan End Glide : A New Donor Inserter for DSAEK. Invest. Ophthalmol. Vis. Sci. 2010;51(13):771.
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© ARVO (1962-2015); The Authors (2016-present)
One of the problems of Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) is donor endothelial cell damage that occurs during donor insertion into the anterior chamber. This is a serious problem especially for Asian eyes, since they tend to have shallow anterior chamber with small corneal diameter. The purpose of this study is to investigate the clinical outcome of a newly developed donor inserter (Tan End Glide: TEG, Network Medical Inc.) for DSAEK in Asian eyes.
Six eyes of 6 patients (mean, 80.2 years) with bullous keratopathy underwent non-Descemet’s Stripping Automated Endothelial Keratoplasty (nDSAEK)(Kobayashi et al. AJO 2008, 146:543-549.). In all cases, donor endothelial lamella was inserted into the anterior chamber with TEG. Endothelial cell counts, postoperative visual acuity and complications during surgery were examined.
In one case, donor endothelial lamellae was folded inside out (endothelium outside) into TEG; the donor was pulled out from the TEG and inserted into the anterior chamber using double-glide technique using Busin glide and intraocular lens glide. The remaining 5 cases had no difficulties during donor insertion, and no intra- and post-operative complications were noted. In 2 cases that reached 3months, best spectacle corrected visual acuity was improved to 20/20 and 20/32 respectively; however, average endothelial cell density decreased to 1711/mm2 after 3 months (mean decrease rate: 29.9%). In the remaining 3 other cases that didn’t reach 3 months postoperatively, epithelial edema after surgery seemed to be stronger than usual, and endothelial cell density was not measurable yet.
TEG was effective and user friendly tool for DSAEK donor insertion, especially for pull-through technique users. However, in this preliminary small case series, superiority of TEG in terms of donor endothelial protection compared to other donor insertion device could not be proven. Further study using large number of patients is needed. Also, it might be required to re-evaluate whether the lumen configuration of TEG (double coil structure) and small lumen diameter is optimal or not.
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