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

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