Descemet's Stripping Endothelial Automated Keratoplasty Using Tan Endoglide Endothelium Insertion System

PurposeThe purpose of this study was to evaluate early visual and refractive outcomes of Descemet's stripping endothelial keratoplasty (DSAEK).MethodNine eyes of 7 male and 2 female patients, mean age 73 years, were treated with DSAEK. Eight had pseudophakic bullous keratopathy and 1 had advanced Fuch's syndrome. Patients were followed up for a mean of 11.4 months (range, 4–26). The DSAEK technique consisted of stripping Descemet's membrane and endothelium from a recipient cornea and transplanting the posterior stroma and endothelium of a donor cornea using the Tan EndoGlide. The mean operating time was 61.89 minutes (standard deviation [SD], 9.3).ResultsThe median donor diameter was 8.375 mm (range, 8.25–8.75) and the mean donor thickness was 114.4 μm (range, 98–129). Mean preoperative sphere was −2.41 that changed postoperatively in −1.21. Mean endothelial cell loss was 25% (range, 23%–45%) at 6 months after surgery. Corneal pachymetry was reduced from 796.6 μm preoperatively to 535.5 μm postoperatively. Best corrected vicual acuity (BCVA) was 20/40 or better postoperatively and exceeded the preoperative BCVA in all eyes. No graft failure was present. Two partial graft dislocations (1st and 5th postoperative day) were observed. One graft was successfully attached after reinjecting an air bubble (rebubbling) in the anterior chamber and the other graft was reattached with 4 10/0 nylon sutures after failed rebubbling.ConclusionsThe key to successful endothelial transplantation is the protection and preservation of as many donor endothelial cells as possible. The TAN EndoGlide is a device that consistently delivers a donor lenticule through a small incision with minimal endothelial loss, while making the insertion procedure relatively reliable and consistent, with the surgeon in full control of the donor at all stages of insertion. The endothelial cell loss during this technique is comparable (if not better) with other endothelial graft insertions systems.