@article{2998175,
    title = "Comparison of endothelial cell loss and complications following DMEK with the use of three different graft injectors",
    author = "Droutsas, K. and Lazaridis, A. and Kymionis, G.D. and Chatzistefanou, K. and Moschos, M.M. and Koutsandrea, C. and Sekundo, W.",
    journal = "Eye (Basingstoke)",
    year = "2018",
    volume = "32",
    number = "1",
    pages = "19-25",
    publisher = "Nature Publishing Group",
    doi = "10.1038/eye.2017.237",
    keywords = "adult;  amblyopia;  Article;  best corrected visual acuity;  comorbidity;  controlled study;  corneal endothelial cell loss;  Descemet membrane endothelial keratoplasty;  female;  follow up;  human;  intraocular hemorrhage;  major clinical study;  male;  retrospective study;  tissue preparation;  trabeculectomy;  vitrectomy;  aged;  cell count;  comparative study;  congenital cornea dystrophy;  cornea endothelium;  corneal endothelial cell loss;  corneal pachymetry;  Descemet stripping endothelial keratoplasty;  devices;  equipment design;  injection;  pathology;  postoperative complication;  time factor;  transplantation;  visual acuity, Aged;  Cell Count;  Corneal Endothelial Cell Loss;  Corneal Pachymetry;  Descemet Stripping Endothelial Keratoplasty;  Endothelium, Corneal;  Equipment Design;  Female;  Follow-Up Studies;  Fuchs' Endothelial Dystrophy;  Humans;  Injections;  Male;  Postoperative Complications;  Retrospective Studies;  Time Factors;  Visual Acuity",
    abstract = "PurposeTo compare endothelial cell loss and complications following Descemet membrane endothelial keratoplasty (DMEK) with use of three commercially available injectors.MethodsFrom 179 consecutive DMEK procedures, 66 cases with uncomplicated graft preparation and completed 12-month follow-up were included in this retrospective study. According to the injector used, 3 groups were formed: group 1 (D.O.R.C. injector, n=16), group 2 (Geuder injector, n=24), and group 3 (Pasteur laboratory pipette, n= 26). Endothelial cell density (ECD) and endothelial cell loss were evaluated preoperatively and at 3, 6 and 12 months postoperatively; surgery-related complications were recorded.ResultsDonor ECD was 2416±179 cells/mm 2 (group 1), 2417±164 cells/mm 2 (group 2), and 2478±234 cells/mm 2 (group 3). At 12 months postoperatively ECD was 1473±403 cells/mm 2 (group 1), 1379±317 cells/mm 2 (group 2), and 1316±456 cells/mm 2 (group 3) (P=0.533, ANOVA). Endothelial cell loss 12 months postoperatively was 39±15% (group 1), 43±13% (group 2), and 47±17% (group 3) (P=0.386, ANOVA). A single case of iris bleeding and reflux of the graft out of the anterior chamber (both in group 3) was noted. Partial graft detachment occurred in group 1 (n=1), group 2 (n=5), and group 3 (n=7) and rebubbling was performed in 6% (group 1), 17% (group 2), and 27% (group 3).ConclusionsTo our knowledge, this is the first clinical study assessing the safety of three different DMEK injectors. Group 1 (D.O.R.C injector) showed the least and group 3 (Pasteur laboratory pipette) the highest endothelial cell loss without reaching statistical significance at 12 months after surgery. Therefore, the graft injector may be chosen according to surgeon's preference. © 2018 Macmillan Publishers Limited, part of Springer Nature. All rights reserved."
}