Endothelial cell loss following needle-push insertion Descemet's Stripping Endothelial Keratoplasty (DSEK)

Session Details

Session Title: Cornea: Surgical I

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 08:24

Venue: Room 10

First Author: : E.Casswell UK

Co Author(s): :    O. Bowes   A. Barsam                 

Abstract Details

Purpose:

To assess the endothelial cell loss following Descemet's stripping endothelial keratoplasty (DSEK) grafting using a novel 30 gauge needle-push/Fichman glide graft insertion technique, which is previously unreported.

Setting:

Retrospective, case series of 16 eyes (n=16) with primary DSEK with or without phacoemusification. Moorfields Eye Hospital, UK

Methods:

Donor corneal grafts were prepared through manual dissection and then cut with a trephine. The graft was then placed on a Fichman glide and inserted through a 5mm incision using a 30 gauge needle with a bent tip, with the needle tip gripping the stromal side of the graft. Main outcome measures were best-corrected visual acuity (BCVA), rate of graft failure and change in endothelial cell density (ECD) were recorded. Change in ECD was determined from baseline preoperative donor and postoperative central endothelial images.

Results:

Mean post-operative BCVA was 0.27 (n=10, range: 0.0-0.78) logarithm of minimum angle of resolution (logMAR) at 12 months. BCVA at 24 months was 0.3 (n=7, range: -0.1-0.78) logMAR. Mean ECD at 15 months was 2155 (n= 9, range: 1692-2584) cells/mm2, with a mean endothelial cell loss of 14.2% (range: -1.3%-27%). Mean ECD at 27.7 months was 1531 (n=6, range: 1371-2345) cells/mm2, with a mean endothelial loss of 28.5% (range: 7.7%-39.1%). 1 case required re-floating of the graft.

Conclusions:

This study suggests that the previously unreported needle-push/Fichman glide DSEK insertion technique results in a low rate of ECD loss compared to other published methods of insertion.

Financial Interest:

NONE