Manual No-fold Push-in DSAEK Graft Insertion Technique

PURPOSE:To describe the manual no-fold push-in technique for Descemet stripping automated endothelial keratoplasty (DSAEK) graft insertion and analyze postoperative endothelial cell loss. METHODS:Twenty consecutive patients underwent DSAEK surgery using the manual no-fold push-in technique. This insertion technique uses a 6-mm limbal wound, a Sheets glide, and a Sinskey hook without the need for an inserter or additional instrumentation. RESULTS:Three patients developed graft dislocation, requiring re-bubbling. No primary graft failures were encountered. With an average postoperative follow-up of 13.22 months (SD, 7.94; range, 2.23–26.87), average automated endothelial cell count was 2329.62 cells per mm (SD, 312.78; range, 1657–2928) and the average cell loss was 23.31% (SD, 11.33; range, 5.56–42.76). CONCLUSIONS:This technique uses standard instrumentation and is simple to perform. This series demonstrates that manual graft insertion techniques can be effectively used in DSAEK surgery and provide patients with excellent postoperative results.