July 02, 2012
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New inserters improve performance and outcomes of endothelial keratoplasty techniques

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ROME — Donor graft inserters play a crucial role in the success of endothelial keratoplasty techniques, according to one surgeon.

“Over the years there has been considerable evolution towards improving donor control, making insertion easier and safer, and limiting endothelial damage in DSAEK,” Donald Tan, MD, said at the joint Refractive.online and SICCSO meeting.

The original taco-folding technique for Descemet’s stripping automated endothelial keratoplasty was step one and produced about 30% endothelial cell loss because there was less control once the donor graft was in the eye. The Busin glide (Moria) and later inserters improved donor control, reducing endothelial cell loss to about 20%. The Tan EndoGlide (Network Medical Products) has further improved safety, limiting endothelial cell loss to approximately 15%. A newer version of the EndoGlide with enhanced characteristics was recently developed and seems ideal for ultrathin DSAEK.

“DMEK, however, still is a problem. We are regressing back to more cell loss because we don’t have enough control, “ Tan said.

A new device, the D-Mat carrier, has recently been tested for Descemet’s membrane endothelial keratoplasty graft insertion. It is shaped like a spatula, 9 mm in diameter and 50 µm thick, to support the endothelial graft and carry it into the eye.

“The donor lamella adheres gently to the D-Mat surface and therefore does not wrinkle up,” Tan said. “The new device has been used in 10 eyes. It allowed DMEK to be performed in a faster and safer way, without touching the donor.”

One case of failure was reported.

  • Disclosure: Tan is a consultant for Network Medical Products.