Changes in Endothelial Cell Morphology after Penetrating Keratoplasty

Izdebska J.,
Warsaw Medical University, Department of Ophthalmology (Warschau)

Purpose: The purpose of the study is to evaluate the changes in endothelial cell morphology after penetrating keratoplasty and the relationship between preoperative diagnosis and postoperative endothelial cell morphology. 
Method: 107 patients who underwent keratoplasty in Ophthalmology Department , Warsaw Medical University between January 1998 and 1999 were included to the study group. All patients were divided into 5 groups according to preoperative diagnosis: 1.aphakic/pseudophakic bullous keratopathy, 2. keratoconus, 3. Fuchs’ dystrophy, 4. vascularized corneal leucoma, 5. nonvascularized corneal leucoma Donor endothelial cell density was performed using eyebank cone of specular microscope at the first day of storage. After surgery recipient endothelial cell count was performed using in vivo contact specular microscope cone, at postoperative follow-up intervals of 6 days, 3 weeks, 3, 6, 12, 24 months. All images were taken from the central area of the donor button and grafted cornea using the specular microscope Tomey EM 1100. Using specular microscopy, endothelial cell density, mean cell area and coefficient of variation of cell area was measured. Endothelial cells morphology was analysed by fully automated method.
Results: The mean endothelial cell density in donor cornea was 2600cell per mm. Endothelial cell loss from preoperative donor levels at 2 years was 42%, mean cell area increased from 386,8 ±12,1 µm² to 686,6±43,0 µm² (78,9%)(mean ± standard deviation) , and coefficient of variation of cell area increased from 44,5 ± 508% to 72,7± 5,9% (63,4%). When cell morphology was examined among the diagnostic subgroups, those in the aphakic/pseudophakic bullous keratopathy subgroup had significantly lower cell density, higher mean cell area and coefficient of variation of cell area when compared to those in the keatoconus subgroup.
Conclusions: In two year studies the decease of endothelial cell density, increase of mean cell area, and coefficient of variation were observed. The most dynamic changes were observed in aphakic/pseudophakic bullous keratopathy group. 3. The preoperative diagnosis seems to be one of the major determinant of the endothelial cell loss in penetrating keratoplasty.

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