Skip to main content
SpringerLink
Log in

Descemet stripping automated endothelial keratoplasty via a frown incision

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To assess the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) via a sclerocorneal frown incision.

Study design

Retrospective comparative study.

Methods

The outcomes of Descement stripping endothelial keratoplasty (DSAEK) were retrospectively compared between 36 patients (36 eyes) who underwent surgery via a 3.8-mm frown incision (frown incision group) and 20 patients (20 eyes) who underwent surgery via a 4.6-mm straight incision (straight incision group). In all patients, an NS Endo-Inserter was used as the graft inserter and the incision for a frown incision was via the superior sclerocorneal site and for the straight incision via the temporal cornea. DSAEK was performed by the standard technique, except for the incision. At 1 year after surgery, the two groups were compared with respect to the visual acuity, decrease of corneal endothelial cell density, the severity of corneal astigmatism (diopters), the number of sutures for wound closure, and intraoperative/postoperative complications.

Results

There was no significant difference between the two groups in terms of postoperative visual acuity, corneal astigmatism, and intraoperative/postoperative complications one year after surgery. On the other hand, the number of sutures required for wound closure was 1.13 ± 0.42 in the frown incision group, whereas in the straight incision group, it was 3.20 ± 0.40, showing a significant difference (P<0.001). In addition, there was no decreased corneal endothelial cell density associated with the reduction in incision width.

Conclusions

A sclerocorneal frown incision is useful for performing DSAEK with an NS Endo-Inserter as it does not affect endothelial cell loss despite its short incision width.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Terry MA, Saad HA, Shamie N, Chen ES, Phillips PM, Friend DJ, et al. Endothelial keratoplasty: the influence of insertion techniques and incision size on donor endothelial survival. Cornea. 2009;28:24–31.

    Article  PubMed  Google Scholar 

  2. Price MO, Bidros M, Gorovoy M, Price FW Jr, Benetz BA, Menegay HJ, et al. Effect of incision width on graft survival and endothelial cell loss after descemet stripping automated endothelial keratoplasty. Cornea. 2010;29:523–7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Singer JA. Frown incision for minimizing induced astigmatism after small incision cataract surgery with rigid optic intraocular lens implantation. J Cataract Refract Surg. 1991;17.

  4. Soma T, Koh S, Maeda N, Mitomo K, Quantock AJ, Nishida K, et al. New graft insertion device for descemet stripping automated endothelial Keratoplasty. Cornea. 2017;36:1432–6.

    Article  PubMed  Google Scholar 

  5. Nakatani S, Murakami A. Descemet stripping automated endothelial keratoplasty for bullous keratopathy after anterior-posterior radial keratotomy. Cornea. 2013;32:1179–82.

    Article  PubMed  Google Scholar 

  6. Nakatani S, Murakami A. Three-year outcome of Descemet stripping automated endothelial keratoplasty for bullous keratopathy after argon laser iridotomy. Cornea. 2014;33:780–4.

    Article  PubMed  Google Scholar 

  7. Nakatani S, Murakami A. Descemet stripping automated endothelial keratoplasty using corneas from elderly donors. Graefes Arch Clin Exp Ophthalmol. 2016;254:1135–40.

    Article  CAS  PubMed  Google Scholar 

  8. Macaluso C. Closed-chamber pulling-injection system for donor graft insertion in endothelial keratoplasty. J Cataract Refract Surg. 2008;34:353–6.

    Article  PubMed  Google Scholar 

  9. Khor WB, Mehta JS, Tan DT. Descemet stripping automated endothelial keratoplasty with a graft insertion device: surgical technique and early clinical results. Am J Ophthalmol. 2011;151:223–32.

    Article  PubMed  Google Scholar 

  10. Ruzza A, Parekh M, Ferrari S, Salvalaio G, Nahum Y, Bovone C, et al. Preloaded donor corneal lenticules in a new validated 3D printed smart storage glide for Descemet stripping automated endothelial keratoplasty. Br J Ophthalmol. 2015;99:1388–95.

    Article  PubMed  Google Scholar 

  11. Khan SN, Shiakolas PS, Mootha VV. Descemet’s Stripping Automated Endothelial Keratoplasty Tissue Insertion Devices. J Ophthalmic Vis Res. 2015;10:461–8.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Gangwani V, Obi A, Hollick EJ. A prospective study comparing EndoGlide and Busin glide insertion techniques in descemet stripping endothelial keratoplasty. Am J Ophthalmol. 2012;153:38–43.

    Article  PubMed  Google Scholar 

  13. Foster JB, Swan KR, Vasan RA, Greven MA, Walter KA. Small-incision Descemet stripping automated endothelial keratoplasty: a comparison of small-incision tissue injector and forceps techniques. Cornea. 2012;31:42–7.

    Article  PubMed  Google Scholar 

  14. Kobayashi A, Yokogawa H, Sugiyama K. Clinical results of the Neusidl Corneal Inserter(R), a new donor inserter for Descemet’s stripping automated endothelial keratoplasty, for small Asian eyes. Ophthalmic Surg Lasers Imaging. 2012;43:311–8.

    Article  PubMed  Google Scholar 

  15. Elbaz U, Yeung SN, Lichtinger A, Zauberman NA, Goldich Y, Ziai S, et al. EndoGlide versus EndoSerter for the insertion of donor graft in descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2014;158:257–62.

    Article  PubMed  Google Scholar 

  16. Soma T, Koh S, Oie Y, Maruyama K, Tsujikawa M, Kawasaki S, et al. Clinical evaluation of a newly developed graft inserter (NS Endo-Inserter) for Descemet stripping automated endothelial keratoplasty. Clin Ophthalmol. 2018;13:43–8.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Gelender H. Management of corneal astigmatism after cataract surgery. Refract Corneal Surg. 1991;7:99–102.

    Article  CAS  PubMed  Google Scholar 

  18. Simşek S, Yaşar T, Demirok A, Clinal A, Yilmaz OF. Effect of superior and temporal clear corneal incisions on astigmatism after sutureless phacoemulsification. J Cataract Refract Surg. 1998;24:515–8.

    Article  PubMed  Google Scholar 

  19. Barequet IS, Yu E, Vitale S, Cassard S, Azar DT, Stark WJ. Astigmatism outcomes of horizontal temporal versus nasal clear corneal incision cataract surgery. J Cataract Refract Surg. 2004;30:418–23.

    Article  PubMed  Google Scholar 

  20. Tejedor J, Pérez-Rodríguez JA. Astigmatic change induced by 2.8-mm corneal incisions for cataract surgery. Invest Ophthalmol Vis Sci. 2009;50:989–94.

    Article  PubMed  Google Scholar 

  21. Fuest M, Ang M, Htoon HM, Tan D, Mehta JS. Long-term visual outcomes comparing descemet stripping automated endothelial keratoplasty and penetrating keratoplasty. Am J Ophthalmol. 2017;182:62–71.

    Article  PubMed  Google Scholar 

  22. Kim SE, Lim SA, Byun YS, Joo CK. Comparison of long-term clinical outcomes between descemet’s stripping automated endothelial keratoplasty and penetrating keratoplasty in patients with bullous keratopathy. Korean J Ophthalmol. 2016;30:443–50.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Droutsas K, Lazaridis A, Papaconstantinou D, Brouzas D, Moschos MM. Visual outcomes after descemet membrane endothelial keratoplasty versus descemet stripping automated endothelial keratoplasty-comparison of specific matched pairs. Cornea. 2016;35:765–71.

    Article  PubMed  Google Scholar 

  24. Jauhari N, Chopra D, Chaurasia RK, Agarwal A. Comparison of surgically induced astigmatism in various incisions in manual small incision cataract surgery. Int J Ophthalmol. 2014;7:1001–4.

    PubMed  PubMed Central  Google Scholar 

  25. Rathi M, Dabas R, Verma R, Rustagi IM, Mathur S, Dhania S. Comparison of surgically induced astigmatism in chevron, straight, and frown incisions in manual small-incision cataract surgery. Indian J Ophthalmol. 2022;70:3865–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tan D, Ang M, Arundhati A, Khor WB. Development of selective lamellar keratoplasty within an Asian corneal transplant program: the Singapore corneal transplant study (an American Ophthalmological Society Thesis. Trans Am Ophthalmol. 2015;113:T10-1–23.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Juntendo University Graduate School of Medicine, 3-1-3 Hongo Bunkyo-ku, Tokyo, 113-8431, Japan

    Satoru Nakatani, Masahiro Yamaguchi & Satoshi Iwamoto

Authors
  1. Satoru Nakatani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masahiro Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Satoshi Iwamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Satoru Nakatani.

Ethics declarations

Conflicts of interest

S. Nakatani, None; S. Iwamoto, None; M. Yamaguchi, None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Corresponding Author: Satoru Nakatani

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nakatani, S., Yamaguchi, M. & Iwamoto, S. Descemet stripping automated endothelial keratoplasty via a frown incision. Jpn J Ophthalmol 68, 50–56 (2024). https://doi.org/10.1007/s10384-023-01038-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10384-023-01038-y

Keywords

Search

Navigation