Busin Glide-Assisted Pull-Through Insertion of Artificial Corneal Endothelium (EndoArt)

Akira Kobayashi,1 Takahiko Hayashi,2 Ami Igarashi,2 Toshiki Shimizu,2 Hideaki Yokogawa,1 Kentaro Yuda,3 Björn Bachmann,4 Satoru Yamagami,2 Kazuhisa Sugiyama1 1Department of Ophthalmology, Kanazawa University Hospital, Ishikawa, Japan; 2Department of Ophthalmology and Department of Visual Sciences, Nihon University School of Medicine, Itabashi, Tokyo, Japan; 3Kikuna Yuda Eye Clinic, Yokohama, Japan; 4Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, GermanyCorrespondence: Akira Kobayashi, Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Takara-machi 13-1, Kanazawa, Ishikawa-ken, 920-8641, Japan, Tel +81-76-265-2403, Fax +81-76-222-9660, Email [email protected]: Currently, the push-in technique through the corneal tunnel using a blunt-tip spatula is used to insert an artificial corneal endothelium (EndoArt) into the anterior chamber (AC). The device is useful for patients with bullous keratopathy; however, it may be difficult to manipulate the very thin implant through hazy cornea. Unlike DMEK graft, it cannot be stained and the F-mark is faint. So, visualizing and orienting the implant is a real challenge especially through a hazy cornea and inadequate AC visualization. Therefore, alternative EndoArt implantation techniques are needed in patients with advanced endothelial dysfunction to avoid complications.Purpose: To report an alternative technique for EndoArt implantation using a Busin glide.Technique: The EndoArt was loaded onto the Busin glide with the concave side of the EndoArt facing upward and was then pulled/pushed into the Busin glide opening. After the Descemet’s membrane and endothelium were detached and removed in a circular fashion in a patient with advanced corneal endothelial decompensation, the Busin glide was inserted into the corneal incision, and the EndoArt was slowly pulled into the AC using retractor forceps. Finally, the air was injected into the AC.Conclusion: The Busin glide-assisted pull-through technique smoothly and securely inserted the EndoArt into the AC without upside-down attachment. This alternative technique can be useful for patients with a history of repeat intraocular surgeries or trauma with severe corneal edema to avoid potential complications such as epithelial implantation cysts or downgrowth.Keywords: endothelial keratoplasty, artificial corneal endothelium, EndoArt, bullous keratopathy, Descemet’s membrane endothelial keratoplasty