Double-Glide Method Using Cathereep Protective Sheet As a Substitute in Descemet's Stripping Automated Endothelial Keratoplasty

Purpose. For the insertion of the donor graft in Descemet's stripping automated endothelial keratoplasty (DSAEK), the double-glide method using a Busin glide and intraocular lens (IOL) glide concomitantly has been shown to be effective. The aim of this report is to evaluate the results for the double-glide method using Cathereep (Nichiban, Tokyo, Japan), a protective sheet made of polyurethane film for medical use, as a substitute for an IOL glide. Materials and Methods. The subjects were 10 eyes of 10 patients with bullous keratopathy. The DSAEK operation was performed, and the double-glide method was used for the donor graft insertion. During the operation, an IOL glide was used for the 5 eyes, and the Cathereep protection sheet was used for the remaining 5 eyes. We trimmed approximately 5？mm wide strips from the nonadhesive area surrounding the Cathereep protection sheet. Results. The donor graft was inserted equally easily with the Cathereep protective sheet and IOL glides and improvement of visual acuity was noted in both groups significantly. A favorable postoperative course was obtained with no perioperative complications including endothelial damage. Conclusions. Cathereep protective sheet can be used as a substitute for an IOL glide for double-glide method in DSAEK. 1. Introduction The operative procedure of keratoplasty has progressed rapidly since the end of the twenty century, and implantations for lesions on a layer-by-layer basis are gradually becoming popular. High among the most popular methods of treating bullous keratopathy over the last decade is Descemet’s stripping automated endothelial keratoplasty (DSAEK) [1–4]. The safety and reliability of the DSAEK procedure is founded upon experimentation with measures designed to minimize the damage to corneal endothelial cells at the time of drawing donor cells into the anterior chamber. One method for the insertion of donor graft is a double-glide method using a Busin glide [5] and an intraocular lens (IOL) glide concomitantly for drawing the donor graft. The usefulness of this method has been reported by Kobayashi et al., and the procedure is increasingly popular [6]. The IOL glide (Alcon Laboratories, Fort Worth, TX, USA) is used to prevent damage to corneal endothelial cells due to direct contact of the donor cells with the iris. Unfortunately, however, the IOL glides are no longer in production, which may interfere with future operations. We found favorable results obtained in the double-glide method using Cathereep (Nichiban Co. Ltd, Tokyo, Japan) protective sheet made of polyurethane