EEBA Program (PDF/3MB) - EEBA - Annual Meeting

INITIAL ENDOTHELIAL CELL LOSS AFTER DSAEK USING A NOVEL DONOR INSERTER.J. Alvarez de Toledo, L. Fernández-Vega Cueto, M. F. de la Paz, P. Sauvageot BeneriaCentro de Oftalmología Barraquer, SpainPurpose: to measure and to evaluate the endothelial cell loss in the first 6 months after Descemet´sstripping automated keratoplasty (DSAEK) using a novel coaxial irrigating donor inserter (Endosaver®,Ocular Systems).Methods: This is a retrospective study on 45 eyes where a standardized DSAEK procedure usinga coaxial irrigating donor inserter through a 4.1 mm. clear corneal incision was performed. Fuchsdystrophy (24/45), bullous keratopathy (14/45) and late endothelial failure after previous penetratingkeratoplasty (7/45) were the main preoperative surgical indications. Surgery was performed underperi-bulbar anaesthesia. In 18 cases, cataract extraction by standard phacoemulsification with afour haptics in-the-bag IOL implantation was performed at the same time, previous to the donorlenticle insertion. After standard descemetorrhexis performed under air or viscoelastic, cornealincision was enlarged to 4.1 mm. Donor posterior lamellar disk was obtained with the Moria 350micron microkeratome head using the artificial anterior chamber. Pachymetry of the donor wasroutinely performed with an ultrasound pachymeter. Donor was cut with a disposable Barron´spunch trephine at the desired diameter. Donor lenticle was then placed onto the Endosaver holdingspatula and folded inside it. The inserter was introduced in the anterior chamber and the donor wasgently inserted while a coaxial irrigation was activated with the phacoemulsification irrigating systemto avoid anterior chamber collapse. Donor was repositioned on the posterior corneal surface by acomplete refilling of the anterior chamber with an air bubble, which was partially removed after tenminutes. Donor preoperative endothelial cell density (ECD) was measured in the eye bank with theKonan Cell-Check EB-04 RU specular microscope. In the postoperative period, non-contact specularmicroscopy (Topcon SP 2000-P) measurements of the donor endothelial cell density were performedafter 1, 3 and 6 months post-op.Results: Donor preoperative mean ECD was 2575 ± 219 (2132/3165) cells/mm2. After 1 month meanECD was 2285 ± 542 (1971 – 3055 ) cells/mm2 indicating an 11,26% endothelial cell loss. After 3months mean ECD was 2177 ± 564 ( 1741 – 2981 ) cells/mm2 , a 15,45 % of endothelial cell loss. After6 months post-op mean ECD was 1979 ± 459 ( 1130 – 2941 ) cells/mm2 meaning a 23,14% endothelialcell loss. No intraoperative complications were observed. Postoperative complications occurred in8 cases including graft dislocation (3/45:6,6%), graft exchange (2/45: 4,4%), conversion to PKP (1/45:2,2%), pupillary block (1/45: 2,2%) and cystoid macular edema (1/45: 2,2 %).Conclusions: endothelial cell loss using a novel irrigating donor inserter is similar to those describedusing other donor insertion techniques. The decreasing of the size of the incision to 4.1 mm. may notimply a significant endothelial cell loss compared to other insertion techniques. The simplicity of useof this inserter has made this technique as our procedure of choice.42