DSEK insertion forceps reduces chance of donor tissue injury during procedure

Irvine, CA-A new design for DSEK insertion forceps minimizes the contact area of the forceps and therefore reduces injury and damage to the donor tissue. The forceps is designed for insertion of folded posterior stromal tissue used in the Descemet's stripping and endothelial keratoplasty (DSEK) procedure.

The new design was the brainchild of Roger F. Steinert, MD, professor of ophthalmology and biomedical engineering and vice chair of clinical ophthalmology, University of California, Irvine.

When the surgeon brings in a back layer of donor cornea, it is done with the tissue folded in half like a taco, with the aid of a trace of viscoelastic against the endothelial layer to assist the fold, Dr. Steinert said, but this can be tricky.

To overcome these problems, Dr. Steinert designed a forceps with two features that make it distinct from others. First, the blades are arched or arced so that they come almost together to grasp the tissue but do not cause any pressure on it that could damage the endothelial cells. In addition, two small pins have been inserted in the distal and proximal ends of the forceps to hold the stromal portion of the tissue.

"It allows you to grasp the donor cornea firmly and stably, bring it in and insert it inside the patient's eye, then release it, all with very minimal tissue injury," he said.

After coming up with the idea for the new forceps, Dr. Steinert approached Rhein Medical Inc., a surgical instrument company with its own manufacturing facilities, to develop a prototype. Dr. Steinert used it in a series of procedures, and with a few modifications to the dimensions, the instrument went into production and is now available from Rhein Medical.

"Everybody that's used it so far has felt that it really solved a problem that hadn't been successfully addressed before," Dr. Steinert said. "It has been very well received.

"It's a very straightforward concept, and it's so immediately clear as to what it does. That's why the people who've seen and used it have understood the benefits and liked it. I haven't heard any complaints so far," he added.

No one else makes insertion forceps like the new DSEK design, according to John Bee, president of Rhein Medical. The DSEK procedure is relatively new, and as is typical of new procedures, it is beginning to spawn innovations in instrumentation, he added.