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- W2078343225 abstract "The pull-through technique of Aralikatti et al. minimizes endothelial trauma by eliminating graft folding and allows insertion of the graft in both standard and problematic eyes (ie, eyes with shallow or unstable anterior chambers, intraoperative floppy iris, or positive posterior pressure). Additional instrumentation including the Busin glide, crocodile vitreoretinal forceps, and an anterior chamber maintainer is required for this technique. The suture-drag technique requires graft folding but, in our hands, allows relatively atraumatic graft insertion without complication. We read with interest the difficulties Aralikatti et al. encountered during their experience using suture-assisted endothelial keratoplasty donor insertion. Their method differs substantially from our technique, and we appreciate the reasons why they “moved on” to other techniques. Our technique involves no knot tying, a substantially larger wound (6.0 to 7.0 mm), and perhaps most important, the incision lips are carefully separated using a Rosenwasser shovel and 0.12 forceps to minimize “squeezing” of the donor graft tissue as it passes through the incision. Lower resistance of donor-graft passage through the incision leads to less striae during the pulling process and less apparent endothelial stress. Increased wound size and an adequate suture bite through the donor graft also minimize the suture tension during insertion and decrease the risk for the suture cutting through the graft. With these modifications, the difficulties described by Aralikatti et al. would be alleviated. These major differences in technique likely led to our overall gratifying experience with our particular technique. The suture-drag technique is easily performed, which adds minimal time to the operating time and allows relatively atraumatic, uncomplicated donor-graft insertion without the need to purchase additional instrumentation. Despite our favorable experience with the suture-drag technique, for efficiency reasons, we consider it an adjunctive technique and not a primary insertion technique. The pull-through technique using the Busin glide and forceps to pull the graft into the anterior chamber without requiring folding appears to be an advancement in the technique of donor-graft insertion to allow rapid atraumatic insertion and unfolding. We applaud Aralikatti et al. for their development of the pull-through technique for donor graft insertion and look forward to further development of insertion processes with a goal of minimizing endothelial trauma with reasonable surgical efficiency." @default.
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- W2078343225 date "2008-03-01" @default.
- W2078343225 modified "2023-09-25" @default.
- W2078343225 title "Reply : Pull-through technique for graft insertion in DSAEK" @default.
- W2078343225 doi "https://doi.org/10.1016/j.jcrs.2007.12.022" @default.
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