Endothelial Cell Density after Posterior Lamellar Keratoplasty: Five- to Seven-Year Follow-up

Purpose: To report endothelial cell density (ECD) after posterior lamellar keratoplasty (PLK). Design: Prospective, interventional case series. Methods: In a single institution, PLK was performed in 15 eyes of 15 patients with pseudophakic bullous keratopathy (PPBK), Fuchs endothelial dystrophy (FED), or both. In 11 eyes, the donor tissue was inserted unfolded through a 9.0-mm sclerocorneal incision. In four eyes, the donor was folded and inserted through a 5.0-mm incision. The ECD measurements were performed in each patient at regular intervals until three years after surgery, and then in all patients simultaneously at 54 to 84 months after surgery. Results: Three patients were not available for follow-up. One graft had decompensated. In the remaining 11 eyes, ECDs ranged from 368 to 1576 cells/mm2. Monophasic and biphasic regression models of ECD against time were fitted for each technique separately. Conclusions: After PLK, ECD declined at a high rate. Both early- and longer-term loss rates may be related to surgical technique.

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