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Hiroko Nakagawa, Tsutomu Inatomi, Shigeru Kinoshita; Comparison of Endothelial Cell Density at the Central and Peripheral Regions in a DSAEK Graft. Invest. Ophthalmol. Vis. Sci. 2013;54(15):1686. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze endothelial remodeling, including the wound healing, at the host/graft junction after Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK), and compare the change of corneal endothelium at the central and peripheral regions of the graft using wide-field specular microscopy.
This study involved 10 eyes of 10 patients (mean age: 72 years) treated by DSAEK using internationally shipped precut donor corneas. None of the patients had ocular complications prior to surgery, and DSAEK was performed via the pull-through technique using a Busin glide. Wide-field contact specular microscopy was used to evaluate the alteration of endothelium at the central and temporal peripheral corneal regions (approximately 1mm inside from the graft edge) at 1, 6, and 12 months after surgery. Endothelial cell density (ECD), coefficient of variation (CV), and the frequency of hexagonal cells (6A) were analyzed to elucidate the post-DSAEK endothelial remodeling pattern.
Mean regional endothelial cell density (cells/mm2±SD) in the center / periphery at 1, 6, and 12 months postoperative were 2286±409 / 1893±432, 2152±464 / 1550±284, and 2138±466 / 1152±378, respectively. Peripheral ECD was statistically lower than central ECD at each follow-up time-point (p<0.05). At 12 months postoperative, peripheral ECD was 38.8±11.6% lower than the central ECD. ECD reduction rates of the central and peripheral regions from 1 to 12 months postoperative were 6.9±7.6% and 29.2±14.7%, respectively. ECD reduction rates of the periphery were statistically higher than of the center (p<0.01). The 6A(%) of the central/peripheral region at 1, 6, and 12 months postoperative were 47.1/46.5, 56.0/55.0, and 58.4/57.1, respectively. CV of the central/peripheral region at 1, 6, and 12 months postoperative were 0.31/0.33, 0.29/0.30, and 0.33/0.29, respectively.
Regional differences of ECD were found in the DSAEK graft. Endothelial cell loss appeared in the peripheral region of the graft and extended to the central region during the endothelial remodeling. Wound healing in the host/graft junction may affect the long-term survival of transplanted endothelium.
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