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Tsutomu Inatomi, Hiroko Adachi, Osamu Hieda, Chie Sotozono, Noriko Yokoi, Shigeru Kinoshita; Corneal Endothelial Cell Alteration Following Descemet-Stripping Automated Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):774.
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© ARVO (1962-2015); The Authors (2016-present)
To report the alteration of corneal endothelial cell density (ECD) after Descemet-Stripping Automated Endothelial Keratoplasty (DSAEK) and compare with that of penetrating keratoplasty (PKP) in laser iridotomy-induced bullous keratopathy.
Corneal endothelial cell alteration after DSAEK and PKP was evaluated by specular microscopy. Subjects involved 117 eyes in 112 cases of DSAEK without any rejection episodes or additional surgeries. The mean follow-up period was 17.6 months (range: 3-39 months, mean age: 72.5±10.8). Ninety eyes with laser iridotomy-induced bullous keratopathy receiving either DSAEK (45eyes) or PKP (45eyes) were used for the retrospective comparative study. In the DSAEK group, pre-cut donor corneas provided by Sight Life TM Eye Bank (Seattle, WA) were inserted using a Busin glide.
The average ECD of the donor corneas post pre-cut was 2932±300 cells/mm2 (Eye Bank records). ECD gradually decreased to 2199±376 cells/mm2 (93eyes), 1927±579 cells/mm2 (57eyes), and 1498±612 cells/mm2 (24eyes), at 1-, 12-, and 24 months post surgery, respectively. The reduction rates of ECD at each of the respective time points between post pre-cut were 25.0%, 34.4%, and 48.9%. The donor condition including age, cause of death, death to preservation preparation time, and preservation time were not significantly associated with the loss of ECD. Accelerated ECD loss was observed only in subjects with pre-existing glaucoma. In the comparative study, no significant ECD difference was observed between preoperative donor corneas. At 1 and 3 months after surgery, the PKP group showed significantly better ECD than the DSAEK group. At 6 months after surgery, ECD of the DSAEK group and PKP group was 2132±398 cells/mm2 and 2264±385 cells/mm2, respectively, thus showing no significant difference, and this tendency continued up to 24 months after surgery. The average donor cornea size was 7.9mm in the DSAEK group and 7.6mm in the PKP group.
The results of this study show that DSAEK using a pre-cut donor cornea is an effective procedure for the recovery of corneal endothelial cell function. Corneal endothelial cell alteration continued after surgery, and from 6 to 24 months postoperative, the loss of ECD in the DSAEK group and PKP group appeared to be equal. However, further investigation is needed to elucidate the long-term change in ECD.
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