Endothelial damage of a donor cornea depending on the donor insertion method during Descemet-stripping automated endothelial keratoplasty in porcine eyes

To compare endothelial damage of the donor cornea in relation to the method of inserting the donor cornea into the recipient anterior chamber during Descemet-stripping automated endothelial keratoplasty (DSAEK). Fifteen enucleated pig eyes were used. The donor corneoscleral buttons were mounted in an artificial anterior chamber. The anterior lamella was excised using a microkeratome and punched using a trephine. The following methods were employed to insert the donor cornea into the recipient anterior chamber: (1) The donor was folded over, grasped using forceps, and inserted ("taco" technique). (2) The forceps were inserted and the edge of the donor was grasped and dragged into the chamber. (3) A loop was made at the edge of the donor by suturing with nylon. A hook was inserted to drag the donor by the loop into the chamber. After insertion, the incision on the recipient eye was extended, and the donor cornea was removed for examination. After vital staining, the samples were examined under a light microscope and a scanning electron microscope. With the taco technique, endothelial damage (17.9%) was observed in areas where the forceps held the donor. In the drag technique using forceps, endothelial damage (17.3%) was observed where the forceps made contact and in the folds in this area. In the drag technique using a suture, endothelial damage (18.8%) was observed in the area of the needle puncture and in folds in this area. The amount of endothelial damage did not differ significantly among the three different methods of donor insertion during DSAEK in this animal model, but each method exhibited a different endothelial damage pattern.