Descemet Stripping Automated Endothelial Keratoplasty With a Donor Insertion Device: Clinical Results and Complications in 100 Eyes

Purpose To study the clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with the EndoGlide donor insertion device. Design Retrospective interventional case series. Methods We included 100 eyes that underwent DSAEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy (PBK) at a single institution. Eyes with anterior segment pathology or previous intraocular surgery (except for uncomplicated cataract surgery) were excluded. Preoperative data included visual acuity and donor endothelial cell density by specular microscopy. The main outcome measures were postoperative best spectacle-corrected visual acuity (BSCVA) and endothelial cell loss at 3, 6, and 12 months. Results There were 59 eyes with Fuchs dystrophy and 41 eyes with PBK. In eyes without vision-limiting pathology, the median postoperative BSCVA was consistently 20/40 (range 20/20-20/400) at 3 months (n = 61 eyes), 6 months (n = 55 eyes), and 12 months (n = 48 eyes). Endothelial cell loss was 13.7% at 3 months (n = 57), 13.5% at 6 months (n = 61), and 14.9% at 12 months (n = 53). Primary graft failure occurred in 1 eye, attributable to incorrect use of the insertion device. Two eyes with complete donor dislocation were rebubbled successfully. The most common complication was glaucoma/ocular hypertension in 29 eyes (34.1%) without prior glaucoma and treatment escalation in 6 eyes (40.0%) with prior glaucoma. Of the 78 eyes with 12 months follow-up, 2 (2.6%) developed endothelial rejection, and 1 (1.3%) subsequently failed. Conclusions The use of this donor insertion device during DSAEK demonstrates good outcomes and potentially low endothelial cell loss at up to 12 months after surgery.