Comparison of Donor Insertion Device to Sheets Glide Technique in DSAEK: 3-Year Outcomes
Narrative Responses:
Purpose
To compare endothelial cell loss and graft survival following Descemet’s stripping automated endothelial keratoplasty (DSAEK) using EndoGlide (AngioTech, Reading, Pennsylvania, USA/Network Medical Products, North Yorkshire, UK) donor insertion device compared to donor insertion using a sheets glide.
Methods
Retrospective, cohort study of consecutive patients who underwent DSAEK with Fuchs’ endothelial dystrophy (FED) or pseudophakic bullous keratopathy (PBK) at a single tertiary center. We compared outcomes from two donor insertion techniques: EndoGlide (TEG) (100 eyes) versus the sheets glide (SG) DSAEK techniques (119 eyes), performed by the same surgeons using the same post-operative treatment regime. Clinical data, donor and recipient characteristics were recorded from our prospective cohort from the Singapore Corneal Transplant Study. Our main outcome measures were percent endothelial cell (EC) loss and graft survival up to 3 years.
Results
Overall percent EC loss was significantly lower in the TEG group compared to SG at 1 year (16.3±16.6% vs. 29.5±22.2%, P<0.001), 2 years (23.8±17.8% vs. 39.5±26.7%, P<0.001) post-operatively; and at 3 years (29.7±10.9% vs. 38.5±24.1%, P=0.015). Overall graft survival was greater in the TEG compared to SG group at 1 year (97.9% vs. 94.1%), 2 years (97.9% vs. 88.2%) and 3 years (97.9% vs. 86.5%, log-rank P value = 0.005). Sub-group analysis revealed a significant superior graft survival comparing TEG-DSAEK versus SG-DSAEK in the PBK group (log-rank P=0.031) but not in the FED group (P=0.303).
Conclusion
The EC loss after DSAEK using the Endoglide resulted in lower EC loss compared to DSAEK using the sheets glide technique in Asian eyes, benefiting patients with PBK more in terms of graft survival; and reduces EC loss in patients with FED.