ENDOTHELIAL CELL COUNT OF THE HOST CORNEA AFTER BLOCK EXCISION

97th DOG Annual Meeting 1999

K92
ENDOTHELIAL CELL COUNT OF THE HOST CORNEA AFTER BLOCK EXCISION

M. J. M. Groh, B. Seitz, G. O. H. Naumann

Block excision of anterior uveal tumors or cystic epithelial ingrowth to the anterior chamber is a curative treatment that leads to morphological rehabilitation of the globe. The purpose of this study was to quantify the host corneal endothelium in the time course after this peripheral corneoscleral graft.

Patients and Methods: Between 1980 and 1999 149 block excisions were performed in our department (90 because of tumors, 59 because of cystic epithelial ingrowth). In this retrospective cross-sectional study 53 specular microscopical photographies of the central host cornea (specular microscope Tomey EM-1000, Erlangen) of 30 patients (19 tumors, 11 epithelial ingrowths) with a mean age at the time of surgery of 49.6 ± 15.6 years were included. Diameter of the block excision was 8.5 ± 1.9 mm (6 mm to 11 mm). The follow-up after surgery ranged from 1 month to 216 months (mean 37.9 ± 47.6 months).

Results: Mean endothelial cell count early postoperatively (< 6 month) was 1890 ± 1134, late postoperatively (> 36 month) cell count was 772 ± 365 cells/mm². Corneal endothelial cell count decreased significantly with follow-up time after block excision (p = 0.05; r = -0.2). We found no significant correlation between cell count and indication for surgery or diameter of block excision. Mean visual acuity before block excision was 16/20 ± 6/20. Visual acuity at the end of the follow-up time was 6/20 ± 6/20. Cell count correlated significantly (p = 0.001; r = 0.5) with the visual acuity at the end of follow-up. In three patients central optical penetrating keratoplasty became necessary because of bullous keratopathy after 3 to 8 years.

Conclusion: Block excision and peripheral tectonic corneoscleral grafting is a curative treatment that leads to morphological rehabilitation of the eye. However there is a significant loss of endothelial cells of the host after surgery, consequently requiring a second central penetrating keratoplasty in some patients. Loss of endothelial cells may be due to the surgical trauma and a chronic immunological reaction against the corneoscleral graft.

Department of Ophthalmology, University Erlangen-Nuernberg

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