Purpose: To evaluate long-term endothelial cell count and thickness of clear corneal grafts after penetrating keratoplasty.
Methods: Specular microscopy and ultrasonic pachymetry were performed in 20 eyes (14 eyes that were keratoconus, three aphakic/pseudophakic bullous keratopathy, one Fuchs dystrophy, one had herpetic keratitis, and one avascular scar after injury) of 18 patients (mean age +/- SD 58+/-15 years; range, 34 to 82 years) with a mean follow-up of 22+/-6 years (range, 15 to 33 years).
Results: Mean endothelial cell count was 808+/-194 cells per mm2 (range, 575 to 1243 cells/mm2), and thickness was 608+/-75 microm (range, 430 to 751 microm). Endothelial cell count was neither correlated with thickness (P = .25, r2 = .08) nor with follow-up interval (P = .31, r2 = .028). We observed predominantly enlarged endothelial cells and mild polymegethism. No graft rejections were recorded.
Conclusion: Despite a reduced cell density, the dehydration function of the endothelium may still be sufficient in corneal grafts up to 33 years after penetrating keratoplasty.