Tsatsos Michael, Athanasiadis Ioannis, Kopsachilis Nikolaos, Krishnan Radhika, Hossain Parwez, Anderson David
Moorfields Eye Hospital, London; Eye Clinic, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Moorfields Eye Hospital, London, UK.
Indian J Ophthalmol. 2017 Nov;65(11):1133-1137. doi: 10.4103/ijo.IJO_360_17.
Minimal loss of corneal endothelial cells during corneal transplantation is a major target but remains a point of controversy among specialists. Hence, the available method to best achieve this continues to stir progress in the field. The aim of this study is to evaluate the use of the Endosaver injector device for graft insertion in Descemet's stripping endothelial keratoplasty (DSEK) and compare the visual outcomes and endothelial cell survival between the Endosaver injector and Goosey grasping forceps insertion techniques.
This was a retrospective, interventional, consecutive case series undertaken at the University of Southampton Eye Department to assess outcomes of DSEK using the Endosaver injector device compared to noninjector DSEK insertion. Postoperative specular microscopy alongside manifest refraction at 6 and 12 months was evaluated and compared. Mann-Whitney U-test was employed for the statistical analysis of data.
Both the Endosaver and Goosey forceps groups showed an improvement in best corrected visual acuity. No significant statistical difference was found in preoperative and postoperative best-corrected visual acuity between the Endosaver and non-Endosaver insertion groups. Mean preoperative endothelial cell count was 2660 (±130) for the Endosaver group and 2608 (±66) for the non-Endosaver group. Postoperative endothelial counts at 6 and 12 months showed a significant difference between the Endosaver: 2104 (±199)-1896 (±226) and the non-Endosaver: 1492 (±207)-1314 (±224) (P < 0.005) groups, respectively.
The Endosaver injection device is associated with less trauma to endothelium during graft insertion due to the minimal touch technique employed. A smaller insertion wound of 4.0 mm compared to noninjector cases enabled a more stable system during surgery with no or minimal anterior chamber shallowing. The combination of a stable host with minimal endothelial graft handling and subsequent trauma potentially leads to higher endothelial cell counts when the Endosaver injection device is used compared to forceps insertion.
角膜移植过程中尽量减少角膜内皮细胞的损失是一个主要目标，但在专家之间仍是一个有争议的问题。因此，能最好实现这一目标的现有方法继续推动该领域的进展。本研究的目的是评估Endosaver注射器装置在Descemet膜剥脱内皮角膜移植术（DSEK）中用于植入移植物的情况，并比较Endosaver注射器和古西抓取镊植入技术之间的视觉效果和内皮细胞存活率。
这是一项在南安普敦大学眼科进行的回顾性、介入性、连续病例系列研究，以评估使用Endosaver注射器装置的DSEK与非注射器DSEK植入术的效果。对术后6个月和12个月的角膜内皮显微镜检查以及明显验光结果进行评估和比较。采用曼-惠特尼U检验对数据进行统计分析。
Endosaver组和古西镊组的最佳矫正视力均有改善。Endosaver植入组和非Endosaver植入组术前和术后最佳矫正视力之间未发现显著统计学差异。Endosaver组术前平均内皮细胞计数为2660（±130），非Endosaver组为2608（±66）。术后6个月和12个月的内皮细胞计数在Endosaver组（2104（±199）-1896（±226））和非Endosaver组（1492（±207）-1314（±224））之间分别显示出显著差异（P<0.005）。
由于采用了最小接触技术，Endosaver注射装置在植入移植物过程中对内皮的损伤较小。与非注射器病例相比，4.0毫米的较小植入伤口使手术过程中的系统更稳定，前房无浅化或浅化最小。与镊植入相比，使用Endosaver注射装置时，稳定的宿主、最小的内皮移植物处理及随后的损伤相结合，可能导致更高的内皮细胞计数。
