Comparison of a Donor Insertion Device to Sheets Glide in Descemet Stripping Endothelial Keratoplasty: 3-Year Outcomes

Abstract

To compare 3-year endothelial cell loss and graft survival following Descemet stripping automated endothelial keratoplasty (DSAEK) using the EndoGlide (AngioTech, Reading, Pennsylvania, USA/Network Medical Products, North Yorkshire, UK) donor insertion device compared to donor insertion using the Sheets glide technique. Retrospective comparative case series. Study involved consecutive patients who underwent DSAEK with Fuchs endothelial dystrophy or pseudophakic bullous keratopathy at a single tertiary center. Clinical data with outcomes and donor and recipient characteristics were obtained from our ongoing prospective cohort from the Singapore Corneal Transplant Study. Main outcome measures were percent endothelial cell loss and graft survival up to 3 years. Overall percent endothelial cell loss was significantly lower in the EndoGlide group (100 eyes) compared to the Sheets glide group (119 eyes) at 1 year (16.3% ± 16.6% vs 29.5% ± 22.2%, P < .001), 2 years (23.8% ± 17.8% vs 35.7% ± 22.9%, P = .001), and 3 years (29.7% ± 20.9% vs 38.5% ± 24.1%, P = .015) postoperatively. Overall graft survival was greater in the EndoGlide compared to Sheets glide group up to 3 years postoperatively (97.9% vs 86.5%, log-rank P value = .005). In eyes with Fuchs endothelial dystrophy, endothelial cell loss was significantly lower in the EndoGlide group (3-year: 28.2% ± 17.9% vs 43.4% ± 27.1%, P = .032). In eyes with pseudophakic bullous keratopathy, the EndoGlide group had a superior graft survival compared to Sheets glide (log-rank P = .031). Endothelial cell loss was lower using a donor insertion device during DSAEK, compared to using the Sheets glide technique for DSAEK, in Asian eyes with Fuchs endothelial dystrophy, and resulted in better graft survival in eyes with pseudophakic bullous keratopathy.