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Importance of axial length and functional corneal endothelial cells in DMEK

Poster Details

First Author: D.Borroni LATVIA

Co Author(s): M. Parekh   Z. Krumina   M. Ferronato              

Abstract Details


To compare the endothelial cell density (ECD) with visual acuity, highlighting the importance of axial length and functional corneal endothelial cells in Descemet Membrane Endothelial Keratoplasty (DMEK).


Riga Stradins University, Riga, Latvia.


25 patients with Pseudophakic Bullous Keratopathy (PBK) between January 2016 and March 2017 were treated with DMEK. The tissues were prepared using stripping method and were implanted by injecting a DMEK roll in the recipient eye. All patients were treated for one week with topical fluoroquinolone (Vigamox, Alcon, Fort Worth, TX, USA) drops in addition to a one-month course of 1% prednisolone acetate (Allergan, Irvine, CA, USA) four times a day following surgery. The ECD was measured using a specular microscope (SP-3000P, Topcon Corp.) at 1, 3 and 6 months post-operation. The axial length was measured with IOL master 500 (Zeiss, Germany).The calculated probability values were 2-tailed, and data showing p<0.05 was deemed to be statistically significantly different. Statistical analyses were performed using IBM SPSS, version 23.0.


Average age of the donors was 59.7±6.8 (M±SD) years, and the mean ECD before stripping was 2710±102 cells/mm2. No occurrence of graft rejections was observed. The relationship between ECL and visual improvement over the first 6 months showed no strict correlations. Visual acuity did not improve nor reduced with decrease in ECD over 6 months (p>0.05) resulting in a speculation that function of each cell is more important than overall number of cells present in DMEK.


From our clinical experience and evidence, we believe that it is not merely the number of cells that contributes to the clarity of the cornea, but the function of the residual cells present in the transplanted graft. The improvements and changes in visual acuity are not directly linked to the reduction of cells and there is no direct or logarithmic correlation that was found. The evidence also suggests that the final improvements in vision are not linked to the vision before the surgery, suggesting that the replacement of endothelium with a new donor tissue in a cloudy cornea will give anatomical and optical replacement of previous functions even if an advanced decompensation is present. Furthermore, the clinical consultations and statistical data show that the clarity and function of the cornea, referred by the patient, is not strictly linked to the number of endothelial cells. It supports the hypothesis that, in order to maintain the corneal stroma dry, the function of every single endothelial cell present is more important than the total number of cells.

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