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A Study of Host Corneal Endothelial Cells After Non-Descemet Stripping Automated Endothelial Keratoplasty

Hatanaka, Hiroki MD; Koizumi, Noriko MD, PhD; Okumura, Naoki MD, PhD; Takahashi, Hiroaki MS; Tanioka, Hidetoshi PhD; Young, Robert D. PhD; Jones, Frances E. BSc; Quantock, Andrew J. PhD; Kinoshita, Shigeru MD, PhD

doi: 10.1097/ICO.0b013e31825d568a
Basic Investigation

Purpose: To determine the short-term fate of the host endothelium and Descemet membrane after non-Descemet stripping automated endothelial keratoplasty (nDSAEK).

Methods: Eight unilateral DSAEK (n = 4) or nDSAEK (n = 4) surgeries were performed in the right eyes of 8 rabbits. Corneal transparency and thickness were followed-up by slit-lamp microscopy, and 2 weeks postoperatively, corneas were evaluated by immunohistochemistry and transmission electron microscopy.

Results: Corneas remained clear after both DSAEK and nDSAEK. One week after DSAEK, the stroma-to-stroma surgical interface was identifiable as a zone of fibrotic tissue a few microns thick, whereas in the nDSAEK group, the recipient corneal endothelium and Descemet membrane were clearly visible at the graft–host interface. The retained endothelial cells were positive for Na+/K+-ATPase but assumed a markedly different morphology from healthy endothelial cells, with cell processes extending into the graft stroma or engulfing strands of irregularly dissected grafted stromal tissue where they occasionally appeared to compartmentalize the transplanted matrix and became detached from the underlying Descemet membrane.

Conclusions: Host endothelial cells 2 weeks after nDSAEK express markers of pump function, but appear to be morphologically altered, occasionally detaching from the adjacent Descemet membrane, extending into the graft stroma or engulfing strands of the grafted stroma at the interface. The short-term persistence and subsequent phenotypical alternation of residual endothelial cells, aligned to structural changes to Descemet membrane, might influence graft adherence after nDSAEK.

*Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan

Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe, Japan

Structural Biophysics Group, School of Optometry and Vision Sciences, Cardiff University, Cardiff, United Kingdom.

Reprints: Noriko Koizumi, Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyotanabe 610-0321, Japan (e-mail:

Supported by the Funding Program for Next Generation World-Leading Researchers from the Cabinet Office in Japan (to N.K.; LS117). Ms Jones is a graduate student funded by the Engineering and Physical Sciences Research Council (United Kingdom).

The authors state that they have no conflicts of interest to declare.

Received October 21, 2011

Accepted May 2, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.