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. 2007 Oct;26(9):1079-81.
doi: 10.1097/ICO.0b013e318142bdde.

Descemet-stripping automated endothelial keratoplasty: effect of inserting forceps on DSAEK donor tissue viability by using an in vitro delivery model and vital dye assay

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Descemet-stripping automated endothelial keratoplasty: effect of inserting forceps on DSAEK donor tissue viability by using an in vitro delivery model and vital dye assay

Takeshi Ide et al. Cornea. 2007 Oct.

Abstract

Purpose: To qualitatively assess the extent and pattern of endothelial trauma on corneal donor Descemet-stripping automated endothelial keratoplasty (DSAEK) buttons resulting from DSAEK insertion forceps.

Methods: An in vitro model was used with corneoscleral rims, DSAEK quality corneal donor tissue, and DSAEK insertion forceps. After insertion of the donor button through the corneoscleral rim, a vital dye assay was used to identify devitalized and necrotic endothelial cells (with alizarin red S and typan blue).

Results: Corneal buttons evaluated with the forceps delivery model showed that, for each arm of the forceps, there were 2 parallel bands of purple/red staining. In addition, orthogonal wrinkles of scattered blue devitalized nuclei were seen in a parallel arrangement.

Conclusions: The DSAEK insertion forceps resulted in a reproducible pattern of endothelial damage. A thorough understanding of iatrogenic endothelial trauma could result in improved forceps design and perhaps help mitigate the high rate of donor dislocation and graft failure in the future.

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