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Very Early Endothelial Cell Loss After Simultaneous Corneal Autograft and Allograft

Campolmi, Nelly MD; Trone, Marie Caroline MD; Nefzaoui, Chaker MD; Aldossary, Mansour MD; He, Zhiguo PhD; Acquart, Sophie PhD; Garraud, Olivier MD, PhD; Forest, Fabien MD; Péoc’h, Michel MD, PhD; Thuret, Gilles MD, PhD; Gain, Philippe MD, PhD

doi: 10.1097/ICO.0000000000000030
Case Report

Purpose: For a better understanding of the very early endothelial cell (EC) loss universally described after all types of keratoplasty, we compared the EC decrease after performing a simultaneous autograft and organ-cultured allograft.

Methods: A 71-year-old woman presented with a central corneal opacity in her left eye and a profoundly amblyopic right eye with a transparent cornea. Both corneas had a normal EC density (ECD). She underwent a left autograft and a right allograft procedure with an organ-cultured cornea, in which the ECD was determined using a calibrated light microscope with image analysis 48 hours before the surgery, that is, just before the final deswelling step with dextran. The postoperative central ECD was determined using specular microscopy on days (D) 1, 2, 3, 4, 5, 15, 20, 30, 60, 90, 120, and 180.

Results: Both grafts were uneventful. For the autograft, the pregraft ECD was 2303 cells per square millimeter, and the cell loss was very low, from 4% (D1) to 3% (D180). For the allograft, the pregraft eye bank ECD was 2787, and this decreased by 32% on D5. On D180, the ECD decrease was almost stabilized at 38%.

Conclusions: This difference between the autograft and allograft, both performed in corneas with a normal peripheral endothelial reserve, indicates that the typical very early postoperative decrease in the EC is not caused mainly by surgery-dependent overmortality. It may be mostly artificial, revealing the overestimation of eye bank ECD caused by the technical unfeasibility of strictly considering living ECs and by measuring the ECD several days before grafting. This exceptional case suggests a new paradigm: surgeons graft fewer ECs than they think.

Supplemental Digital Content is Available in the Text.

*Corneal Graft Biology, Engineering and Imaging Laboratory, Federative Institute of Research in Sciences and Health Engineering, Jean Monnet University, Saint-Etienne, France;

Department of Ophthalmology, University Hospital of Saint-Etienne, France;

Eye Bank of Saint-Etienne, Auvergne Loire Blood Center, Saint-Etienne, France;

§Department of Pathology, University Hospital of Saint-Etienne, France; and

Institut Universitaire de France, Boulevard Saint-Michel, Paris, France.

Reprints: Gilles Thuret, Corneal Graft Biology, Engineering and Imaging Laboratory, EA 2521, SFR143, Jean Monnet University, 15, Rue Ambroise Paré, F 42023 Saint-Etienne Cedex 2, France (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Supported partly by the French National Research Agency (ANR), TecSan 2012 program, CORRIMO 3D project. The sponsor or funding organization had no role in the design or conduct of this research.

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

Received June 18, 2013

Accepted October 08, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.