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Clinical Factors for Early and Late Endothelial Cell Loss After Corneal Transplantation

  • Cornea (P Hamrah and T Yamaguchi, Section Editors)
  • Published:
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Abstract

Purpose of Review

To consider the relative importance of factors associated with post-keratoplasty endothelial cell loss.

Recent Findings

Lamellar keratoplasty continues to supplant penetrating keratoplasty. When host endothelium is healthy, retaining it with deep anterior lamellar keratoplasty significantly reduces long-term endothelial cell loss. Endothelial keratoplasty and penetrating keratoplasty differ fundamentally in relative rates of early and late central endothelial cell loss, yet at 10 years, their cumulative cell loss is similarly substantial. The greatest risk factor for post-keratoplasty endothelial decompensation is prior glaucoma filtration surgery, particularly an aqueous shunt. Interestingly, vital dye staining and sophisticated imaging software suggest that the actual viable endothelial cell density of donor corneas is often overestimated by specular microscopy, inflating estimates of early cell loss.

Summary

Corneal graft longevity is often determined by endothelial cell survival. Adoption of new surgical techniques has improved graft survival, and new imaging techniques allow more accurate preoperative endothelial cell evaluation.

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Authors and Affiliations

  1. Cornea Research Foundation of America, 9002 N. Meridian St., Suite 212, Indianapolis, IN, 46260, USA

    Marianne O. Price

  2. University Hospitals Eye Institute, Case Western Reserve University, Cleveland, OH, USA

    Jonathan H. Lass

  3. Price Vision Group, Indianapolis, IN, USA

    Francis W. Price Jr

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  1. Marianne O. Price
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  2. Jonathan H. Lass
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Correspondence to Marianne O. Price.

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Price, M.O., Lass, J.H. & Price, F.W. Clinical Factors for Early and Late Endothelial Cell Loss After Corneal Transplantation. Curr Ophthalmol Rep 6, 191–199 (2018). https://doi.org/10.1007/s40135-018-0179-y

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