Eyeworld

EW CORNEA 132 October 2016 less compression during insertion with possible endothelium damage; and the potential for a smaller inci- sion size. Disadvantages of a smaller graft include fewer endothelial cells and the potential for greater visual significance of imperfect centration. Since much of the visual disabil- ity of Fuchs' dystrophy is related to the optical effects of guttae and not just corneal edema, a smaller graft may be satisfactory for improved vision, and in fact, studies have shown that smaller graft size is not associated with lower final endothe- lial cell count. The eighth question was, "What method do you use to insert the donor lenticule into the anterior chamber?" by Mitchell Gossman, MD Graft size is a tradeoff. Some advantages of a larger graft are: a larger optical zone; more endothelial cells, which lowers the risk of graft decompensation; more forgiving of decentration; and a greater distance of the central donor from the aberra- tions induced by the graft edge, such as edema and folds. Disadvantages of a larger graft are: greater com- pression and potential for cell loss during folding and insertion; more tedious unfolding; and potential for peripheral anterior synechiae at the graft edge. On the other hand, advantages of a smaller graft are: simpler un- folding; easier access to the anterior chamber for fluid and air injection; Second of a three-part series exploring the methods practicing ophthalmologists use when performing DSAEK T his article, the second of a three-part series, further explores what methods are being used by practicing ophthalmologists in per- forming DSAEK surgery. A survey was performed of 23 ophthalmologists who volunteered to participate from the ranks of par- ticipants of the eyeCONNECTIONS online community and volunteers in North America. Responses are anonymous in order to encourage candor. The first part of this series, pub- lished in the August 2016 issue of EyeWorld, summarized the first five Comparison of methods for performing DSAEK Pulse of ophthalmology: Survey of clinical practices and opinion Mitchell Gossman, MD 7.5 mm 0 7.75 mm 0 8.0 mm 48% 8.25 mm 22% 8.5 mm 26% 8.75 mm 0 9.0 mm 4% 9.25 mm 0 9.5 mm 0 3.0 mm 4% 3.5 mm 9% 4.0 mm 39% 4.5 mm 4% 5.0 mm 35% 5.5 mm 9% 6.0 mm 0% survey questions, covering the topics of anesthesia preference, incision size, and removing Descemet's. The sixth question in the survey was, "What diameter graft for Fuchs' in a normal-sized cornea?" Busin glide 30% Commercial insertion device, e.g., EndoGlide 28% Folding forceps 17% Push in along Sheets glide with needle 25% Suture pull-through 0% The seventh question was, "What diameter graft for endothelial failure (e.g., post-phaco decompen- sation) in a normal-sized cornea?" Folding forceps are relatively straightforward, but it can be chal- lenging to keep track of which side is up and require a wider incision of at least 50% of the graft diameter. EndoGlide and others are elegant and fast and can insert a graft through a small incision, but there is an associated expense. Sheets glide method is fast, easy, quick, and there is little ambiguity about graft orientation, but there may be endothelial loss from the endothe- lial side gliding along the surface. Busin glide is reusable and offers the potential for a smaller incision, but especially with larger grafts, the folding process may result in graft compression with resulting endothe- lial cell loss. Personally I started with folding forceps and moved to the FRIDAY, MAY 5 LOS ANGELES HOUSING IS NOW OPEN Book early to guarantee your preferred hotel. www.corneaday.org

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