Endothelial damage with two DSAEK insertion techniques performed by a novice corneal surgeon in residency training: A comparative analysis

PURPOSE:: The aim was to determine which of 2 commonly used nonfold donor insertion techniques was advantageous for initial Descemet stripping automated endothelial keratoplasty (DSAEK) cases. METHODS:: This involved an ex vivo, prospective comparative case series of 20 randomized DSAEK lenticule insertions. DSAEK insertions were performed by a single novice corneal surgeon (PGY4 resident) in human cadaver eyes. Ten grafts were inserted using a Sheet glide (Surgical Glide; Beaver-Visitec International Inc, Waltham, MA) and 10 were inserted using an inserter device (EndoSerter; Ocular Systems Inc, Winston-Salem, NC). The grafts were explanted, stained with trypan blue and alizarin red S, and photographed for comparison with 5 control grafts. Endothelial damage was quantitatively evaluated using Adobe Photoshop 10.0 CS3 software (Adobe Systems, San Jose, CA). RESULTS:: Endothelial cell loss (ECL) was 7.10% ± 2.27% in controls, 12.31% ± 4.74% in the inserter group, and 13.31% ± 5.46% in the Sheet glide group (P = 0.07). Early cases (cases 1-5) had a greater ECL compared with what later cases had (cases 6-10) for the Sheet glide group. This difference was significant for the Sheet glide group (40.42% reduction for cases 6-10, P = 0.04) but not for the EndoSerter group (32.5% reduction for cases 6-10, P = 0.11). CONCLUSIONS:: Quantitative analysis revealed no statistically significant difference in the ECL between the 2 methods. With surgeon experience, there was a trend toward less ECL using both methods but especially with the Sheet glide. A novice corneal surgeon may effectively use either of these nonfold methods for initial cases. The cadaver eye model described may be a potentially useful wet-laboratory tool for novice surgeons to practice DSAEK lenticule insertion.