Ocular surface outcomes for patients with OSST rejection are poor, with the majority of patients having failed ocular surfaces despite treatment with increased immunosuppression and repeat OSST. It is critical for success that OSST patients are closely monitored for rejection and for compliance with immunosuppression.

Endothelial keratoplasty has largely replaced penetrating keratoplasty as the preferred technique to selectively replace diseased corneal endothelium. Descemet's stripping automated endothelial keratoplasty (DSAEK) is the most common type of endothelial keratoplasty performed worldwide. One of the challenges in DSAEK is the insertion of the donor lenticule into the eye using a method so as to minimize endothelial cell loss. Various techniques have been suggested such as forceps insertion and graft insertion devices. With the trend towards using thinner DSAEK tissue and Descemet membrane endothelial keratoplasty, there are increasing challenges in inserting and manipulating even more delicate tissue. The EndoGlide Ultrathin has several new features that will enable easier insertion of thinner DSAEK tissue. This paper presents the features and surgical technique of the EndoGlide Ultrathin during DSAEK.