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Immediate Endothelial Cell Loss After Penetrating Keratoplasty

Alqudah, Asem A. MD; Terry, Mark A. MD; Straiko, Michael D. MD; Greiner, Mark A. MD; Davis-Boozer, David MPH

doi: 10.1097/ICO.0b013e3182a73822
Basic Investigation

Purpose: To report the pattern and the extent of corneal endothelial cell loss immediately after a penetrating keratoplasty (PK) is performed.

Methods: Ten donor corneal-scleral tissues with healthy endothelium were used to perform 10 PK surgeries on cadaver eyes. An 8.25-mm donor graft was placed into an 8.00-mm trephinated recipient bed of the cadaver eye. A 10-0 nylon suture was used with a 16-interrupted suture closure technique to secure each donor button. Viscoelastic was used to protect the endothelium in every case. The corneal donor buttons were removed and stained using trypan blue and alizarin red dyes. Digital high-definition photographs were obtained to record the pattern and quantity of stain resulting from endothelial damage and cell loss. Percent endothelial loss was calculated using the digital planimetry of our previously described Adobe Photoshop technique.

Results: The immediate mean percent cell loss across the whole graft was 25.7% ± 7.5% (Range, 18–39). There was a distinct pattern of loss, with 58.3% of the loss in the peripheral 0.75 mm, and 12.4% of the loss in the central 3.00 mm.

Conclusions: The immediate total endothelial cell loss after the PK was performed was about 25%. The immediate cell loss after the PK was consistent with areas of trephination and suture placement.

*Cornea Service, Devers Eye Institute, Portland, OR; and

Lions VisionGift Research Laboratory, Portland, OR.

Reprints: David Davis-Boozer, Devers Eye Institute, 1040 NW 22nd Avenue, Portland, OR 97210 (e-mail:

Supported by the Lions VisionGift Research Laboratory, Portland, Oregon.

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

Received March 05, 2013

Accepted July 27, 2013

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