EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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July 2012 Figure 4. The conical opening of the transparent saddle of the EndoGlide UT enables more optimal coiling of thin donor tissue Source (all): Donald Tan, F.R.C.Ophth. prevent descent of the donor onto the iris, and only then should the donor be released from the forceps. Full wound closure, centration of the donor, a complete air tampon- ade, and completion of the DSAEK procedure may then be performed in the usual manner. EndoGlide Ultrathin (UT) version With increasing use of thinner donor tissue (ultrathin DSAEK) to sub-100 µm thicknesses, which may result in better vision, a second ver- sion of the EndoGlide, EndoGlide Ultrathin (UT), has been designed, with improved ease of donor coiling for thinner tissues between 50-100 µm. It incorporates a detachable coiling saddle with a conical front end that enables easy coiling with- out the need to stroke the sides of the donor upward in most cases, unless the donor is less than 50 µm. The EndoGlide UT also has a higher donor well platform, which allows for placement of just the posterior lenticule in situations where only the posterior lenticule is supplied by the eye bank. The EndoGlide UT may also be used for thicker donor tissue (100-250 µm). Technique of donor loading using the EndoGlide UT: Fill the well and the cartridge with balanced salt solution and place both the an- terior and posterior lenticules of the donor in the well. Gently remove the anterior lenticule and position the posterior lenticule adjacent to the cartridge opening. Once the donor is close to the entrance, it may then be further drawn toward the cartridge opening by wicking away balanced salt solution from the front of the cartridge, using a dry Weck cell sponge placed at the front open end of the cartridge. As fluid is drawn forward through the cartridge chamber into the sponge, the donor will usually also be drawn by capil- lary action right up to the entrance of the cartridge. Place a thin strip of dispersive viscoelastic onto the donor, and pull the donor into the cartridge with the straight loading EndoGlide forceps (Figure 4). As the donor tissue enters the capsule, the sides of the donor tissue will natu- rally curl upward, without wrin- kling, along the upward curving walls of the saddle tunnel, and the tissue will form a double coil config- uration in the cartridge. Unlike the EndoGlide Classic, it is usually un- necessary to use a cannula to stroke the edges of the donor upward along the sidewalls of the chamber, unless the donor is extra thin (e.g., sub-50 µm). Remove the detachable trans- parent saddle, and attach the intro- ducer to the back of the cartridge and remove from the preparation base for insertion. Early clinical results with the EndoGlide UT have been encourag- ing with no cases of graft dislocation or graft failure in the first 20 cases (unpublished data). Another advan- tage of the EndoGlide donor inserter is the possibility of precut and pre- loaded donor delivery by eye banks, which further simplifies DSAEK surgery for surgeons. A recent study presented at the 2012 ASCRS•ASOA Symposium & Congress showed there was minimal cell damage after the donor corneas were stored for 24 hours preloaded in the EndoGlide. Following our initial wet lab work, we are using precut and preloaded donors for our clinical cases. More data will be required to confirm our early positive safety and efficacy results. EW Editors' note: Dr. Tan is medical director, Singapore National Eye Centre. He has financial interests with Angiotech, Alcon (Fort Worth, Texas), Bausch + Lomb (Rochester, N.Y.), Santen (Osaka, Japan), Moria (Antony, France), Carl Zeiss Meditec (Jena, Germany), AcuFocus (Irvine, Calif.), and Technolas Perfect Vision (Munich, Germany). Contact information Tan: snecdt@pacific.net.sg Seibel* Nucleus Choppers For Vertical & Horizontal Chopping, Available In Stainless & Titanium... i b i b The Seibel* Horizontal Safety Chopper: Unique Mirror Polished Olive Tip With Offset Bevels, Ideal For Peripheral Chopping In Line With The Phaco Incision. Available In Stainless & Titanium. The Seibel* Vertical Safety Chopper: Special Offset Converging Bevels On The Distal Segment Make This An Effi cient & Effective Quick Chopper While Protecting The Posterior Capsule. Available In Stainless & Titanium. Call 800-637-4346 For More Information 3360 Scherer Drive, Suite B, St. Petersburg, FL 33716 s4EL s&AX 9OUNG7OMANAT(ER4OILET 4ITIAN 1314 Rev.A AJBA %MAIL )NFO 2HEIN-EDICAL COMs7EBSITE WWW 2HEIN-EDICAL COM $EVELOPED)N#OORDINATION7ITH"ARRY3 3EIBEL - $ S e e l S e e l * * H V o e r r i t i c z a l o S afety n t a l Chopper S afety Chop per