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Hiroko Nakagawa, Tsutomu Inatomi, Osamu Hieda, Chie Sotozono, Shigeru Kinoshita; Wide·field Contact Specular Microscopy Analysis Of Post·DSAEK Endothelial Cell Remodeling. Invest. Ophthalmol. Vis. Sci. 2012;53(14):23.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this present study was to investigate the change of corneal endothelium after Descemet’s-Stripping Automated Endothelial Keratoplasty (DSAEK). To that end, endothelial remodeling including the wound healing at the host/graft junction was analyzed using wide-field specular microscopy.
This study involved 164 eyes of 155 patients (mean age: 73 years) treated by DSAEK using internationally shipped precut donor corneas. Patients who had a post-DSAEK rejection or any additional surgery were excluded. All cases underwent the same surgical procedure using the pull-through technique. Postoperative endothelial cell density (ECD) at the central cornea was monitored with a noncontact specular microscope. A newly-built, specially-designed, wide-field contact specular microscope was also used to evaluate the alteration of endothelium at the central and temporal peripheral corneal regions (approximately 1mm inside from the graft edge). ECD, coefficient of variation (CV), and frequency of hexagonal cell (6A) were analyzed to elucidate the post-DSAEK endothelial remodeling pattern.
In all cases, average ECD of the donor corneas before precut was 2919 cells/mm2. ECD at 1, 6, 12, and 24 months post surgery were 2185, 2088, 2014, and 1832 cells/mm2, respectively. Regional endothelial density (central/peripheral) measured by the new wide-field contact specular microscope at 1, 3, and 6 months post surgery were 1885/1661, 1853/1483, and 1733/1479, respectively. Central ECD was statistically higher than peripheral ECD at all time point (p<0.05). ECD reduction rates of the central/peripheral region from 1 to 3 and 3 to 6 months were 2.0/6.5% and 11.1/1.3%, respectively Moreover, 6A of the central/peripheral region at 1, 3, and 6 months post surgery were 51.1/49.6, 55.5/49.7, and 58.5/55.1%, respectively.
The corneal endothelial cells showed the reduction of the number following the endothelial survival and remodeling after DSAEK. Endothelial cell loss appeared in the peripheral graft region and extended to the central region during the post-DSAEK endothelial remodeling. Wound healing in the host/graft junction may be crucial for the long-term survival of transplanted endothelium.
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