Endothelial Cell Loss in Autologous versus Homologous Corneal Grafts

Abstract

Abstract: : Introduction: The nature of chronic endothelial cell loss in homologous corneal grafts is still unclear. Possible causes are cell migration to the periphery and chronic subclinical immune reaction. In this study we compare endothelial cell loss after autologous rotation keratoplasty where immune reactions naturally can be ruled out and homologous keratoplasty. Moreover we present clinical outcome of patients after rotation keratoplasty. Material and methods: In this open prospective study we included seven consecutive patients that underwent rotation keratoplasty between 1998 and 2000 in our clinic. Patients were examined clinically every 6 months and visual acuity, astigmatism and endothelial cell density were collected. Endothelial cell densities were compared to endothelial cell counts of 219 non high risk homologous keratoplasties. Results: Mean follow-up was 39 months. Mean increase in visual acuity was 3.5 lines. Mean astigmatism was 4.1 dpt. Mean preoperative endothelial cell density was 2063 cells /qmm mean endothelial cell density at end of follow-up was 1865 cells/qmm which represents a mean cell loss of 15.7% during follow-up period. endothelial cell loss in the same period in homologous grafts was 45%. There was one decompensation of autologous graft in follow-up period. Conclusions: Endothelial cell loss in autologous grafts is significantly lower than in homologous grafts which supports the hypothesis that chronic endothelial cell loss is due to chronic subclinical immune reactions in homologous grafts. Autologous keratoplasties can lead to good functional results and can be superior to homologous corneal grafting in suitable situations.

Keywords: cornea: endothelium • cornea: clinical science • clinical (human) or epidemiologic studies: out