Comparison of Bifold Forceps and Cartridge Injector Suture Pull-through Insertion Techniques for Descemet Stripping Automated Endothelial Keratoplasty

Abstract

To compare the outcome of bifold forceps and cartridge injector suture pull-through insertion techniques for Descemet stripping automated endothelial keratoplasty (DSAEK). A retrospective review was conducted of the medical records of all patients treated with DSAEK at the University of Iowa Hospitals and Clinics from January 1, 2005 to July 1, 2007. The main outcome measures (endothelial cell loss, graft survival, and visual acuity) were evaluated postoperatively at 1, 3, 6, 12, and 24 months. Of 179 DSAEK procedures carried out during the study period, the bifold forceps insertion technique was used in 143 cases and the cartridge injector suture pull-through insertion technique was performed in 36 cases. The mean follow-up was 17.4 ± 9.5 months and 19.1 ± 11.0 months for the 2 groups, respectively. No significant differences were detected in postoperative complications, endothelial cell loss, visual acuity, or graft survival between the 2 groups. At 12 months postoperatively, the forceps and pull-through insertion groups had a mean endothelial cell loss of 42.5% ± 23.0% and 51.4% ± 26.1%, respectively. After 1 postoperative year, the mean logarithm of the minimum angle of resolution vision values were 0.171 ± 0.015 (Snellen equivalent = 20/30) in the forceps group and 0.253 ± 0.039 (Snellen equivalent = 20/36) in the pull-through group. At the most recent examination, 136 (95.1%) forceps insertion and 35 (97.2%) pull-through insertion grafts were clear. Bifold forceps and suture pull-through insertion techniques are associated with similar surgical outcomes after DSAEK.