DSAEK (Not Only) in Asian Eyes: What Glide to Use? Optimised Insertion Techniques

Endothelial keratoplasty in Asia presents a unique set of challenges. These include anatomical differences such as small anterior chambers and high vitreous pressure in Asian patients and a disease profile including advanced endothelial failure secondary to a higher incidence of pseudophakic bullous keratopathy and infectious causes of endothelial cell damage such as cytomegalovirus endotheliitis. The conventional insertion of the corneal tissue adopted in Western populations by folding or employing an external glide resulted in unacceptable endothelial cell loss and graft failure in Asian patients. To circumvent these problems, a radically different approach to safely deliver donor lamellar material resulted in the creation and employment of an enclosed endothelial keratoplasty insertion device, the EndoGlide. By altering the approach to selective corneal transplantation, improved survival and outcomes have been achieved in circumstances that would otherwise have not been possible. Furthermore the adoption of the EndoGlide has facilitated safe and effective corneal transplantation outside of Asian populations. In this chapter, we discuss the rationale and evolution of a corneal endothelial insertion device.