Long-Term Maintenance of Corneal Endothelial Cell Density After Corneal Transplantation

Cornea. 2020 Dec;39(12):1510-1515. doi: 10.1097/ICO.0000000000002386.


Purpose: To investigate the key factors associated with eyes with an endothelial cell density (ECD) of ≥2000 cells/mm at 5 years after corneal transplantation.

Methods: This retrospective cohort study included 174 eyes that underwent penetrating keratoplasty by 1 corneal specialist surgeon at the Baptist Eye Institute, Kyoto, Japan, from 1998 through 2011 and that were carefully followed for over 5 years postoperative. In all operated eyes, corneal ECD was measured at 1, 2, 3, 4, and 5 years postoperative. Multivariate analysis with adjustment for preoperative donor ECD was performed between eyes with an ECD of ≥2000 cells/mm and those with an ECD of <2000 cells/mm at 5 years postoperative.

Results: Of the 174 eligible eyes, 16 eyes (9.2%) had an ECD of ≥2000 cells/mm at 5 years postoperative, and the annual rate of endothelial cell loss (mean ± SD) was 2.3% ± 3.7%. Multivariate analysis findings revealed that the donor-associated and surgery-related factors were not significant factors. Only the recipient diagnosis of bullous keratopathy was significantly associated with an ECD of <2000 cells/mm at 5 years postoperative. Of those 16 eyes, 6 (37.5%) had a recipient diagnosis of bullous keratopathy.

Conclusions: None of the donor- and surgery-related factors, previously recognized as associated with a lower endothelial cell loss after penetrating keratoplasty, were found to be significant in this study, thus suggesting that there are still unknown factors associated with maintaining a higher ECD over the long-term postoperative period.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cell Count
  • Corneal Diseases / physiopathology
  • Corneal Diseases / surgery*
  • Corneal Endothelial Cell Loss / diagnosis*
  • Corneal Endothelial Cell Loss / physiopathology
  • Endothelium, Corneal / pathology*
  • Female
  • Follow-Up Studies
  • Graft Survival / physiology
  • Humans
  • Keratoplasty, Penetrating*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Tissue Donors
  • Transplant Recipients
  • Young Adult