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A. Kobayashi, H. Yokogawa, K. Sugiyama; Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) for Bullous Keratopathies Secondary to Argon Laser Iridotomy -Usefulness of Double-Glide Insertion Technique-. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2309.
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DSAEK currently requires folding of the donor for insertion, and subsequent manipulation in the anterior chamber to unfold the donor. However, those manipulations are sometimes difficult in eyes with shallow anterior chamber, especially in eyes secondary to argon laser iridotomy (ALI)-induced bullous keratopathies (BK) that is a growing problem particularly in Japan. We recently developed a novel non-folding donor insertion technique using two glides: Busin glide and IOL sheets glide. The purpose of the current study is to evaluate the clinical outcome of DSAEK for ALI-induced BK using several different insertion techniques.
Thirteen women and one male (mean, 74.2±4.9 years) with ALI-induced BK underwent DSAEK; simultaneous cataract surgery was performed in 12 cases. Different method of donor lamella insertion was used: (1)taco-folding method (n=4), (2)spatula-assisted method (n=3), (3)Busin glide assisted method (n=2), (4)Busin glide/IOL glide assisted method (n=5). Follow-up ranged from 58 to 458 days (mean, 228.3±132.2 days). Endothelial cell counts, postoperative visual acuity, induced astigmatism and complications were examined.
In one case, DSAEK was impossible due to difficulties in donor insertion by taco-folding method, resulted in vitreous prolapse; procedure was converted to penetrating keratoplasty. Postoperative endothelial cell counts ranged from 853 to 2610 cells/mm2 (mean, 1654.2±532.3 cells/mm2; mean postoperative day,228.3±132.2), a 44.9% reduction compared with donor counts (mean, 3003.3±425.5 cells/mm2). All DSAEK cases (100%) reached acuity more than 20/40. Three cases reached 20/20 (23.1%). Mean induced astigmatism in measurable cases was 0.81D±0.91D. Although not statistically significant due to small sample numbers, the use of Busin glide with (37.9%) or without IOL glide (37.0%) tended to cause less endothelial damages compared to taco-folding (49.0%) and pull-through with spatula method (44.2%) at 3 months postoperatively.
DSAEK is effective for rehabilitation of eyes with ALI-induced BK. Our results suggest that the donor insertion with Busin glide enabled reliable donor insertion, and showed decreased endothelial cell damage compared to conventional taco-folding technique. Simultaneous use of IOL glide help to prevent iris prolapse, assisting the Busin glide technique. Currently, this double-glide technique is our preferred donor insertion method of DSAEK for narrow angle eyes.
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