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We don’t graft as many endothelial cells as we think (part 2): comparison of cell loss after autograft and organ cultured allograft in the same patient
Author(s) -
TRONE M,
NEFZAOUI C,
ALDOSSARY M,
CAMPOLMI N,
ACQUART S,
GARRAUD O,
THURET G,
GAIN P
Publication year - 2012
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2012.t109.x
Subject(s) - cornea , eye bank , medicine , ophthalmology , corneal transplantation , surgery , corneal transplant , transplantation , corneal graft
Purpose Reasons for endothelial cell density (ECD) decrease after corneal grafts remain unclear. We recently demonstrated that eye bank ECD (ebECD) overestimates the pool of viable EC really grafted to patients (Pipparelli.IOVS2011;52:6018) because standard ebECD cannot take account of acellular areas or area covered by dying EC. Autograft is a very rare situation where ECD can be easily determined by specular microscopy just before graft and almost all grafted EC are living. Aim: to compare EC decrease after simultaneous autograft and organ cultured (OC) allograft in the same patient Methods A 71 year‐old woman presented with pseudophakic corneal edema in left eye and amblyopic right eye with a normal cornea. She underwent two penetrating keratoplasties (PK): autograft of the left eye and allograft of the right eye with an OC cornea. Follow‐up at day (D)1, 5, 15, 20 and 30 comprised slit lamp examination and non‐contact central specular microscopy (Topcon SP2000P) Results Both grafts were uneventful. For the allograft, ebECD 48h before graft was 2787 cells/mm² and postop ECD decreased of 39%, 40%, 40% and 43% at D5, 15, 20 and 30. For the autograft, pregraft specular ECD was 2017 cells/mm² and postop ECD were 1941, 1934, 1924, 1909 and 1900 cells/mm² respectively at D1, 5, 15, 20 and 30 Conclusion This exceptional case confirms a dramatic discrepancy between ebECD and very early postop ECD, likely to be explained mainly by an overestimation of the true EC pool of viable cells by standard eye banks count, rather than by overmortality due to peri‐operative events, since almost no early cell loss is observed during autograft