Descemet's stripping automated endothelial keratoplasty injecting device

Abstract

In summary, DSAEK has been a revolutionary change in the treatment of endothelial disorders, avoiding the need for the more invasive PKP. However, it is not without its problems, one of which is the trauma that can befall the delicate endothelial graft when it is manipulated by forceps. As a possible solution, surgeons and companies are developing injectors and/or glides that may be able to insert the graft with less trauma to the endothelial cells. At this point, there are five innovative injectors and two glides that may hit the market in the near future. Depending on the surgeons' preferences, their surgical techniques and economical situations, the requirements for the inserting device may vary. However, to make the best use of a limited supply of donor corneas and to achieve good long-term results, surgeons should perform the least traumatic surgeries on donor endothelium in any situation. In this respect, the injectors look more promising than the glides. Although it is controversial if surgeons have to use these devices (especially DSAEK experts), we have to examine the fact that the number of DSAEK surgeons is increasing due to its apparent simple techniques. Even in the hands of a DSAEK expert, the endothelial damage is reported to be more severe than that in PKP. We believe the future of donor insertion for posterior lamellar grafting will lie in using an injection system so that the surgeon can rely on a more reproducible and safer means of delivering the necessary tissue. No matter how careful one is while using forceps, the point of forceps is to squeeze and that is not what we want to do to a donor graft. These innovations on DSAEK inserting glide and injector may obviate all five complications previously described and we are looking forward to having ex vivo and in vivo study results in the future, although none of these injectors have been US FDA 510 (K) -cleared yet. © 2009 Expert Reviews Ltd.