Evidence of Endothelial Cell Migration after Descemet Membrane Endothelial Keratoplasty

Abstract

Purpose: : To investigate the hypothesis that adult corneal endothelial cells can migrate after Descemet Membrane Endothelial Keratoplasty (DMEK).

Methods: : Eight patients with Fuchs endothelial dystrophy were examined one year after uneventful DMEK. These patients had been selected on the basis of slightly decentered grafts and/or large descemetorrhexis and showed areas of denuded corneal stroma which were neither covered by the patients` Descemet Membrane (DM) nor the graft. These areas were investigated by in vivo confocal laser scanning microscopy (CLSM) using a specially designed Heidelberg Retina Tomograph II and Rostock cornea module equipped with a custom-made software. Source data (frame rate 30 Hz, 384x384 pixels, 400x400 µm) were used to create large-scale maps of the scanned area in Automatic Real Time composite mode. In each case an on-line mapping with maximum size up to 3.2 x 3.2 mm (3072 x 3072 pixel) was performed.

Results: : In vivo CLSM of areas devoid of DM revealed endothelial cells in all patients observed. The morphology of these cells was similar to that of endothelial cells on DM-grafts but different from the morphology of the patient’s own endothelium suggesting migration of donor endothelial cells from DMEK grafts.

Conclusions: : The results strongly support the hypothesis that adult corneal endothelial cells are able to migrate in the human eye. Furthermore we provide evidence to support the hypothesis that grafted endothelium migrates onto the host tissue.

Keywords: cornea: endothelium • transplantation • microscopy: confocal/tunneling