Elsevier

Japanese Journal of Ophthalmology

Volume 46, Issue 2, March–April 2002, Pages 189-192
Japanese Journal of Ophthalmology

Clinical investigations
Corneal Endothelial Cell Changes Twenty Years After Penetrating Keratoplasty

https://doi.org/10.1016/S0021-5155(01)00485-3Get rights and content

Abstract

Purpose: To evaluate retrospectively the corneal endothelium in 15 eyes which showed clear cornea for 20 years or longer after penetrating keratoplasty.

Methods: The corneal endothelium was investigated in 15 eyes. The causative lesion had been keratoconus in 10 eyes and herpetic keratitis in 5 eyes. At the time of surgery, the patients were aged from 6 to 45 years, average 25.3 ± 10.4 years. The endothelial cell density was measured 10 and 20 years after surgery by specular microscope. The relation between the rate of endothelial cell density loss and postoperative graft rejection, final visual acuity, causative corneal lesion, age of the patient, and age of the donor was evaluated.

Results: The endothelial cell population per mm2 averaged 998 ± 343 ten years after surgery and 852 ± 245 twenty years after surgery. The rate of endothelial cell density loss thus averaged 12.1% ± 16.3% during the last 10 years. This rate was independent of postoperative graft rejection, final visual acuity, causative corneal lesion, age of the patient, or age of the donor.

Conclusions: The corneal endothelial cells become stabilized 10 years after surgery in cases where the grafts remain transparent 20 years after surgery.

Introduction

Penetrating keratoplasty (PK) is a very common form of corneal transplantation. Corneal clarity following PK depends on the maintenance of the endothelial cells in the transplanted cornea. In some cases, the endothelial cells did not decrease after PK;1 in others, a decrease was reported.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12 There are a few reports about endothelial cell loss during a long postoperative period.3, 4, 5, 6, 7, 8 Endothelial cell loss occurred for several years and rapidly in the first year postoperatively.8, 9, 10, 11, 12 The rate of endothelial cell loss was reported to be 10.4–17.0% at 2 weeks after PK, 16.0% at 1 month, 18.3–33.0% at 3 months, 39.4% at 6 months, and 33.6–48.2% at 12 months.8, 9, 10, 11, 12 During the long postoperative period, the rate of endothelial cell density loss per year was reported at 150% by 2 months after PK, 20% between 2 months and 2 years, 7.3% between 2 and 5 years, and 1.3% between 5 and 20 years.3 The rate of endothelial cell density loss per year was reported at 4.2% between 5 and 10 years after PK.8

We evaluated the corneal endothelial cell density only in cases showing clear cornea for 20 years or longer after PK.

Section snippets

Materials and Methods

We made a retrospective study of the records of 15 PK surgery patients who showed clear cornea for 20 years or longer after PK. The surgery had been performed at the Tokyo University Hospital between July 1970 and February 1978. Endothelial cell density was measured at 10 and 20 years following PK. These 15 transplants were performed on 13 patients (9 male and 4 female patients) (Table 1). The causative lesion was keratoconus in 10 eyes and herpetic keratitis in 5 eyes. In Table 1, cases 2 and

Results

The overall endothelial cell density averaged 998 ± 343 cells/mm2 (range, 645–1,980 cells/mm2) 10 years after PK, and 852 ± 245 cells/mm2 (range, 622–1,569 cells/mm2) 20 years after PK (Table 2). The rate of endothelial cell density loss had averaged 12.1 ± 16.3% over the last 10 years.

The endothelial cell density 10 years after PK averaged 879 ± 162 cells/mm2 (range, 645–1,124 cells/mm2) in keratoconus eyes and 1,235 ± 497 cells/mm2 (range, 779–1,980 cells/mm2) in herpetic keratitis eyes. The

Discussion

Owing to recent developments in surgical techniques, materials, and postoperative management, indications for PK have been extended to high-risk patients with conditions such as regrafting, bullous keratopathy, or chemical burn. One of the most important factors that effects the clinical outcome of PK is still allograft rejection.13 As high-risk patients are more likely to suffer from allograft rejection than low-risk ones, their outcomes after PK have not been good.13

In this study, we

Acknowledgements

A Japanese version of this paper was published in Rinsho Ganka (Jpn J Clin Ophthalmol) 2001;55:685–9. With the permission of Igaku Shoin, the publisher of Rinsho Ganka, it appears here in a modified form after peer review and editing for The Japanese Journal of Ophthalmology.

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