New Graft Insertion Device for Descemet Stripping Automated Endothelial Keratoplasty

Purpose: Corneal endothelial dysfunction is a major indication for corneal graft surgery worldwide, and although surgical intervention through a range of posterior lamellar surgeries has proven to be hugely beneficial, challenges remain. This is especially so where the anterior chamber is relatively shallow, as is often the case in the Asian population, though not exclusively so. In this study, we introduce a new insertion device to deliver endothelial graft tissue for Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: A new surgical tool was designed and manufactured so as to enable a 1-step insertion of corneal graft tissue into the anterior chamber based on a pressure–flow concept, rather than the a pull-through one. This was tested ex vivo to assess endothelial cell damage, and then performed in 12 first-in-human surgeries. Results: Precut DSAEK lenticules implanted in donor corneas ex vivo through the new technique showed that less endothelial cell damage occurs compared with a pull-through technique. Grafts were successful in all patients receiving the new surgery, with no cases of primary graft failure. Conclusions: The newly developed DSAEK inserter is a simple and useful tool for endothelial graft delivery, lessening intraoperative mechanical stress on the graft tissue.