Descemet-stripping automated endothelial keratoplasty: Effect of inserting forceps on DSAEK donor tissue viability by using an in vitro delivery model and vital dye assay

Takeshi Ide, Sonia H. Yoo, James M. Goldman, Victor Perez, Terrence P. O'Brien

Research output: Contribution to journalArticle

38 Scopus citations


PURPOSE: To qualitatively assess the extent and pattern of endothelial trauma on corneal donor Descemet-stripping automated endothelial keratoplasty (DSAEK) buttons resulting from DSAEK insertion forceps. METHODS: An in vitro model was used with corneoscleral rims, DSAEK quality corneal donor tissue, and DSAEK insertion forceps. After insertion of the donor button through the corneoscleral rim, a vital dye assay was used to identify devitalized and necrotic endothelial cells (with alizarin red S and typan blue). RESULTS: Corneal buttons evaluated with the forceps delivery model showed that, for each arm of the forceps, there were 2 parallel bands of purple/red staining. In addition, orthogonal wrinkles of scattered blue devitalized nuclei were seen in a parallel arrangement. CONCLUSIONS: The DSAEK insertion forceps resulted in a reproducible pattern of endothelial damage. A thorough understanding of iatrogenic endothelial trauma could result in improved forceps design and perhaps help mitigate the high rate of donor dislocation and graft failure in the future.

Original languageEnglish (US)
Pages (from-to)1079-1081
Number of pages3
Issue number9
StatePublished - Oct 1 2007



  • Descemet-stripping automated endothelial keratoplasty
  • Descemet-stripping endothelial keratoplasty
  • Endothelial damage
  • Forceps
  • Staining

ASJC Scopus subject areas

  • Ophthalmology

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