Intraocular forceps enable alternative Descemet stripping automated endothelial keratoplasty transplantation technique

Key Points

The DSAEK procedure is evolving rapidly and there are many ways of inserting the donor tissue.

His contribution to streamlining the pull-through technique utilizes 23-gauge forceps that can easily maneuver the donor button through a sideport incision using a modified lens glide. The forceps are inserted through a 1-mm incision in the nasal limbus, which required engineering them so that they could be manipulated to avoid hitting areas such as the bridge of the nose.

Another objective was to have a forceps that could be inserted through a very small paracentesis (1 mm). Dr. Tan said that to his knowledge, the new DSAEK forceps are the narrowest and smallest on the market at this time.

He also wanted forceps with a single rather than a double shaft and faced the formidable challenge of creating a tip that could grip the thin donor lenticule without causing any damage.

"I designed the forceps tip to grip the stromal side so that you don't touch the endothelium at all," Dr. Tan said. The tips of the forceps pinch just the upper stromal layer of the donor button.

The tip also was designed to securely grip the donor button during transplantation yet cleanly release it when it was correctly positioned. To achieve the combination of a firm grip but no sharp points, Dr. Tan decided to use a serrated blunt tip, somewhat like that of crocodile tip forceps.

The body is all titanium with an ergonomic handle. Although designed with the DSAEK procedure in mind, it has other applications, including peripheral iridectomy, pupil reconstruction, and gripping membranes of the haptics of IOLs.

"It's my intraocular forceps of choice now," Dr. Tan said.