Corneal endothelium in penetrating keratoplasty

Specular microscopy of endothelium after corneal transplantation has often shown a sharp reduction in its number density immediately after surgery and long-term cell loss during the next three to four years in addition to continuous morphologic changes. We examined flat preparations of the endothelium of three corneal buttons removed three weeks, eight weeks, and 11 months after penetrating keratoplasty and compared them to similar preparations from the corneal rims of the respective donors. We did not find significant morphologic changes, and direct endothelial cell counts disclosed an endothelial cell loss of 3.8% at three weeks, 2.6% at eight weeks, and 5.6% at 11 months after keratoplasty. We believe the lack of endothelial cell loss and absence of morphologic changes in these specimens are direct results of our surgical technique.