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Do we overestimate the endothelial cell

Session Details

Session Title: Cornea

Session Date/Time: Sunday 16/02/2014 | 08:30-11:00

Paper Time: 09:54

Venue: Linhart Hall (Level -2)

First Author: : JackParker USA

Co Author(s): :    Ruth Quilendrino   Isabel Dapena   Lisanne Ham   Silke Oellerich   Gerrit Melles  

Abstract Details


To evaluate how corneal deturgescence after Descemet membrane endothelial keratoplasty (DMEK) influences the posterior corneal surface area and the endothelial cell density (ECD) measurements.


Non-randomized, prospective clinical study, at a tertiary referral center. Netherlands Institute for Innovative Ocular Surgery, Rotterdam


A mathematical model was formulated to estimate the increase in posterior corneal surface area associated with postoperative corneal deturgescence and its effect on ECD measurements. Important input parameter for the model was the change in pachymetry from 1 hour to 6 months after surgery. To this end, the clinical records of 25 patients (25 eyes) that underwent DMEK were reviewed retrospectively and the central corneal thickness (CCT) measurements taken after 1 hour, 1 month, 3 months and 6 months were noted. ECD measurements before surgery and at 1, 3 and 6 months after surgery were also recorded and decrease in pachymetry and ECD loss were calculated.


The average decrease in CCT due to corneal deturgescence was 267 µm (±39 µm), which corresponds to an 8.6% increase in total posterior corneal surface area, as calculated using our mathematical model. The stretching of the endothelial cell layer associated with this increase of posterior corneal surface area may result in an apparent endothelial cell ‘loss’. This might account for approximately 25% of the observed average ECD decrease of 34% (±17%).


The observed decrease in ECD within the first six months after DMEK may overestimate the actual loss of endothelial cells by about 8% due to increased posterior corneal surface area associated with postoperative corneal deturgescence. FINANCIAL INTEREST: NONE