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Are Polymegethism, Pleomorphism, and Poor Swelling Valid Discard Parameters in Immediate Postmortem Evaluation of Human Donor Corneal Endothelium?

Bruinsma, Marieke PhD*,†; Lie, Jessica T. PhD; Groeneveld-van Beek, Esther A. MSc; Liarakos, Vasilis S. MD*,‡; van der Wees, Jacqueline PhD; Melles, Gerrit R. J. MD, PhD*,†,‡

doi: 10.1097/ICO.0b013e318253b1a6
Clinical Science

Purpose: To study the validity of endothelial polymegethism, pleomorphism, and “poor swelling” as tissue discard parameters in the immediate postmortem evaluation of human donor corneal endothelium.

Methods: We retrospectively evaluated the quality of the endothelium at first and second evaluations for all processed corneas exhibiting moderate polymegethism, pleomorphism, or “poor swelling” in our eye bank over a 5-year period.

Results: Out of 2008 eyes qualifying for our study, 422 corneas (21%) showed polymegethism, pleomorphism, or poor swelling at the first tissue evaluation immediately after excision of the corneoscleral button. In 363 (86%) of these corneas, a normal endothelial mosaic was observed at the second tissue evaluation after 7 to 21 days of organ culture, whereas only 59 (14%) still showed persistent polymegethism, pleomorphism, or “poor swelling” at that time point.

Conclusions: A recovery of normal endothelial cell mosaic and “normal swelling” at the second evaluation suggests that cellular contour parameters do not relate to tissue viability, but rather to a cellular stress reaction. If so, the validity of endothelial cellular contour morphology as an early parameter in assessing the suitability of a donor cornea for transplantation may be reconsidered.

Author Information

*Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands

Amnitrans EyeBank Rotterdam, Rotterdam, The Netherlands

Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands.

Reprints: Gerrit R. J. Melles, Netherlands Institute for Innovative Ocular Surgery, Laan op Zuid 88, 3071 AA Rotterdam, The Netherlands (e-mail:

The authors have no funding or conflicts of interest to disclose.

Dr Melles is a consultant for Dutch Ophthalmic Research Center International/Dutch Ophthalmic USA.

Received December 22, 2011

Accepted March 1, 2012

© 2013 Lippincott Williams & Wilkins, Inc.