Objective Assessment Of Corneal Transparency After Artificial Endothelial Implantation Using Pentacam Densitometry
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR271 | Type: Free paper | DOI: 10.82333/4wxq-c865
Authors: Dr Natalie Di Geronimo 1 , A/Prof. Antonio Moramarco 2 , Dr Giovanni Zanini 3 , A/Prof. Maurizio Mete 3 , A/Prof. Luigi Fontana* 3
1IRCCS Azienda Ospedaliero-Universitaria di Bologna,Bologna,Italy, 2Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche,Alma Mater Studiorum University of Bologna,Bologna,Italy;IRCCS Azienda Ospedaliero-Universitaria di Bologna,Bologna,Italy;Ophthalmology Unit,Santa Maria delle Croci Hospital,Ravenna,Italy, 3Ophthalmology Unit, Dipartimento di Scienze Mediche e Chirurgiche,Alma Mater Studiorum University of Bologna,Bologna,Italy;IRCCS Azienda Ospedaliero-Universitaria di Bologna,Bologna,Italy
Purpose
To evaluate corneal transparency after artificial endothelial implantation using Scheimpflug camera corneal densitometry and to investigate its relationship with central corneal thickness (CCT). The study aimed to objectively assess whether the EndoArt synthetic endothelial implant can improve corneal clarity in patients with chronic corneal edema and to determine the stability of this effect over time, particularly in complex eyes with previous graft failure or significant ocular comorbidities.
Setting
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Ophthalmology Unit.
Methods
This retrospective study included eight patients (mean age 74 ± 8 years) affected by chronic corneal edema secondary to endothelial keratoplasty failure or bullous keratopathy. Corrected distance visual acuity (CDVA), CCT, and corneal densitometry were evaluated preoperatively and at 3, 6, and 12 months after EndoArt implantation. Densitometry was measured with Pentacam in three concentric zones (0–2, 2–6, and 6–10 mm). Statistical analysis included paired t-tests and Spearman correlation to assess changes over time and the relationship between densitometry and CCT.
Results
CDVA improved from 1.35 ± 0.23 logMAR preoperatively to 0.94 ± 0.34 at 12 months (P = 0.02). Mean CCT decreased from 883.7 ± 171 µm to 511 ± 71 µm at 3 months, 580 ± 104 µm at 6 months, and 578 ± 101 µm at 12 months (P < 0.05). At 3 months, densitometry significantly decreased in all zones: zone 1 from 51.8 ± 17.8 to 39.4 ± 11.9 (P = 0.005), zone 2 from 46.6 ± 14.6 to 37.3 ± 8.3 (P = 0.01), and zone 3 from 47.6 ± 10.8 to 44 ± 7.5 (P = 0.05). Reduced densitometry values were maintained at later follow-up. A positive correlation between CCT and central densitometry was observed at baseline (ρ = 0.86, P = 0.007) and at 12 months (ρ = 0.90, P = 0.002).
Conclusions
Artificial endothelial implantation with EndoArt provided significant and sustained improvement in corneal deturgescence and optical quality in complex eyes with chronic endothelial failure. Scheimpflug camera corneal densitometry proved to be a sensitive and reproducible biomarker, allowing objective monitoring of transparency changes beyond visual acuity. The early reduction and long-term stabilization of densitometry values suggest restoration of corneal homeostasis and durability of the device’s barrier effect. These findings support artificial endothelial implantation as a reliable alternative in high-risk corneas and highlight densitometry as a key outcome measure in future studies.