A Modified Technique for Descemet Membrane Stripping Automated Endothelial Keratoplasty to Minimize Endothelial Cell Loss

In an attempt to enhance postoperative survival of donor endothelium, the conventional technique for Descemet membrane stripping automated endothelial keratoplasty (DSAEK) was modified using the prototype of a glide specially designed to facilitate graft delivery and minimize surgical trauma. Instead of using the so-called taco technique, the Busin glide is loaded with the donor lamella, and a microincision forceps is inserted into a temporal side entry and passed across the anterior chamber, exiting through a nasal clear cornea tunnel to grab the graft and drag it into the eye. In 10 patients who underwent DSAEK, mean (SD) postoperative endothelial cell loss was 20.0% (2.6%) at 6 months, 23.5% (2.8%) at 12 months, and 26.4% (2.7%) at 18 to 24 months. Reduced trauma to the graft using our modified technique limits endothelial cell loss after DSAEK to the level recorded after conventional penetrating keratoplasty (PK).