Endothelial cell loss rate after penetrating keratoplasty: Optical versus therapeutic grafts

Abstract Background: This study aimed to compare the rate of endothelial cell loss (ECL) after penetrating keratoplasty (PKP) for optical versus therapeutic grafts at ۳-, ۶-, and ۱۲-month postoperatively. Furthermore, the study aimed to investigate postoperative graft viability and the rate of graft rejection during the first year of follow-up for both indications. Methods: This was a prospective, observational, comparative study that included patients who sought medical advice at the cornea outpatient clinic of Ain Shams University Hospitals, Cairo, Egypt. The study recruited ۶۰ patients: group ۱ included ۳۰ transplanted corneas of ۳۰ patients who underwent optical PKP for various indications, while group ۲ included ۳۰ transplanted corneas of ۳۰ patients who underwent therapeutic PKP for unhealed, resistant infectious keratitis. Specular microscopy was performed for all patients at the ۳-, ۶-, and ۱۲-month follow-up visits using Nidek CEM-۵۳۰ specular microscopy. Postoperative clinical examinations were performed at the same follow-up visits to detect graft rejection. Results: There were no statistically significant differences between the groups concerning the postoperative timing of graft clarity or the rate of ECL at ۳- and ۶-months postoperatively; however, the rate of ECL was significantly greater in group ۲ than in group ۱ at ۱۲-months postoperatively (P = ۰.۰۳), although the difference was small from a clinical point of view. Moreover, there was no statistically significant difference between the groups in terms of the graft rejection rate. Conclusions: Therapeutic PKP results were comparable to optical PKP with respect to graft viability, the rate of ECL, and the rate of graft rejection ۱ year after grafting.