Descemet stripping automated endothelial keratoplasty with the EndoGlide Ultrathin graft insertion device

Abstract

Endothelial keratoplasty has largely replaced penetrating keratoplasty as the preferred technique to selectively replace diseased corneal endothelium. Descemet’s stripping automated endothelial keratoplasty (DSAEK) is the most common type of endothelial keratoplasty performed worldwide. One of the challenges in DSAEK is the insertion of the donor lenticule into the eye using a method so as to minimize endothelial cell loss. Various techniques have been suggested such as forceps insertion and graft insertion devices. With the trend towards using thinner DSAEK tissue and Descemet membrane endothelial keratoplasty, there are increasing challenges in inserting and manipulating even more delicate tissue. The EndoGlide Ultrathin has several new features that will enable easier insertion of thinner DSAEK tissue. This paper presents the features and surgical technique of the EndoGlide Ultrathin during DSAEK.

Keywords::

• Descemet stripping automated endothelial keratoplasty
• EndoGlide
• endothelial keratoplasty
• inserter
• ultrathin

Financial & competing interests disclosure

JS Mehta and DT Tan currently hold patents on the EndoGlide Ultrathin and receive royalties. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Descemet’s stripping automated endothelial keratoplasty (DSAEK) has largely replaced penetrating keratoplasty as the preferred technique to selectively replace diseased corneal endothelium.

• One of the challenges in DSAEK is the insertion of the donor lenticule into the eye using a method so as to minimize endothelial cell loss.

• The original EndoGlide has shown comparable or favorable endothelial cell loss compared to other inserters/devices.

• The EndoGlide Ultrathin is a progression of the original device designed to further enhance the loading and insertion of donor lenticules, particularly thinner lenticules.

• The early safety and efficacy results of the use of the EndoGlide Ultrathin suggest this device to be a safe inserter, with no cases of primary graft failure and a mean endothelial loss comparable to that of the original EndoGlide.

• Further evaluation of the EndoGlide Ultrathin with more cases and longer follow-up of endothelial cell loss and visual acuity are in progress.