Purpose: To study the long-term effect of 193 nm excimer laser photorefractive keratectomy (PRK) on the human corneal endothelial cell density.
Subjects and methods: One hundred and twenty-four eyes from 71 patients underwent photorefractive keratectomy for myopia or myopic-astigmatism. Endothelial cell density was examined a short time before the operation and on an average of 50 months after the operation using a contact specular microscope. A subgroup of 32 eyes from 20 patients treated only once was examined preoperatively and 7 and 52 months postoperatively. The endothelial cell densities were corrected for the changing magnification of the contact specular microscope with changing central corneal thickness and for the expected physiological cell loss with time.
Results: The average endothelial cell density was preoperatively 3098+/-283 cells/mm2 (mean+/-SD) and postoperatively 3048+/-294 cells/mm2 corresponding to a change of -50+/-157 cells/mm2. This was statistically significantly different from zero in a paired t-test (n=124, t=3.58, 2p<0.001). The average changes in endothelial cell density for the subgroup were -34+/-159 cells/mm2 for the postoperative time interval 0-7 months and -20+/-188 cells/mm2 for the postoperative time interval 7-52 months. These results were not statistically significantly different from zero in a paired t-test (n=32, t=1.21 and t=0.60, 2p>0.05). A statistically significant negative correlation between preoperative cell density and the change in cell density was found (n=124, r=-0.21, 2p<0.05).
Conclusion: This study suggests a potentially harmful effect of PRK on the human corneal endothelium. It appears that most cells are lost during ablation or within the first period of time after PRK.