Assessment of endothelial cell density after deep anterior lamellar keratoplasty

Abstract

Background The fundamental aim of successful Keratoplasty is to obtain a clear corneal graft and to maintain its survival. Previous studies have demonstrated the importance of endothelial cell density (ECD) in maintaining graft transparency and survival after keratoplasty. Objective This study aimed to assess the changes in corneal ECD following deep anterior lamellar keratoplasty (DALK) and to evaluate its visual and surgical outcomes. Patients and methods This prospective observational study was conducted at the National Eye Institute Rod-Elfarag, Cairo, Egypt, between July 2020 and February 2022. It included 50 eyes of 50 patients, with pathologies affecting the epithelium and/or stroma for whom DALK was performed. Patients with comorbidities affecting the endothelium were excluded from the study. Preoperative, intraoperative, and postoperative data, including ECD, were collected. Postoperative assessments were conducted at 1, 3, and 6 months. Results The mean age of the patients was 24.80±2.81 years (range=21–30 years), with 60% of the patients being males. The preoperative diagnoses included keratoconus, granular dystrophy, macular dystrophy, and corneal scarring. The ECD significantly decreased from a baseline value of 2726.6±188.53 cells/mm2 to 2591±175.79 cells/mm2 at 1 month, 2461.3±155.43 cells/mm2 at 3 months, and to 2349.9±104.58 cells/mm2 at 6 months postoperatively (P<0.001). The best corrected visual acuity improved significantly from a preoperative value of 0.06±0.02 to 0.61±0.15 at 6 months, postoperatively (P<0.001). The postoperative complications included a double anterior chamber (in 2 eyes) and wrinkling of Descemet’s membrane (in 2 eyes). Conclusion DALK led to a significant reduction in ECD over the first 6 months postoperatively, with improvement in best corrected visual acuity. The study highlights the importance of considering ECD changes and visual outcomes in DALK patients. Preservation of the patient’s endothelium may contribute to better long-term outcomes, with careful consideration of the potential complications.