To compare a new insertion method using a suture with the standard forceps-assisted insertion of the lamellar corneal graft in Descemet stripping automated endothelial keratoplasty (DSAEK).

Interventional, comparative case series.

DSAEK was performed on 28 consecutive eyes of 28 patients (mean age ± standard deviation, 72.5 ± 9.7 years; 12 males). The donor tissue was prepared using the Moria automated lamellar therapeutic keratectomy microkeratome head with a 300-mm blade depth on a Moria artificial anterior chamber (Moria, Antony, France). The central 9 mm of the recipient's Descemet membrane were stripped through a superior limbal incision. In eight consecutive unselected patients, a 10-0 monofilament suture on a long straight needle was used to insert the folded donor lenticula into the recipient's eye, whereas in the other 20 patients, a standard insertion forceps was used. During the suture insertion, an anterior chamber maintainer was used to fill the anterior chamber continuously with balanced salt solution to prevent its collapse.

Suture-assisted DSAEK did not differ significantly from forceps-assisted DSAEK in any of the preoperative parameters. No significant differences were noted in the intraoperative or postoperative complications. Six months after surgery, there were no significant differences in endothelial cell counts (1804 vs 1935 cells/mm², respectively), visual acuity (20/40 vs 20/36, respectively), or refraction (spherical equivalent, 0.93 vs 1.05 diopters, respectively).

Suture-assisted DSAEK is a valid alternative to forceps insertion; however, it does not seem to offer a significant advantage.