Long Term Outcomes Of Artificial Corneal Endothelial Transplant (Endoart): A Single, Tertiary Centre Cohort

To evaluate longer-term anatomical and functional outcomes of artificial corneal endothelial transplant (EndoArt) in complex endothelial failure, often after multiple grafts and glaucoma surgery, in a tertiary UK centre. We report corneal thickness, visual acuity, and complication profile, including rebubbling, resuturing and intraocular pressure (IOP) changes, to assess the role of EndoArt as a keratoplasty-sparing option in high‑risk eyes.

Single-surgeon series at a UK tertiary referral corneal service with a high proportion of graft‑failure and glaucoma‑tube eyes. 

Retrospective consecutive case series of 15 eyes undergoing EndoArt for endothelial decompensation, including failed penetrating keratoplasty (PK), Descemet membrane endothelial keratoplasty (DMEK), Descemet stripping automated endothelial keratoplasty (DSAEK), and primary or secondary endothelial failure. Demographics, indications, prior grafts, glaucoma surgery, and comorbid retinal or infectious pathology (fungal keratitis, herpes simplex, prior retinal detachment surgery) were recorded. Central corneal thickness (pachymetry) was collected preoperatively and at early (1 week–1 month) and late follow‑up. Best‑corrected distance visual acuity (BCDVA), IOP, and need for resuturing or rebubbling were analysed at the last visit.​

Fifteen eyes from 15 patients (mean age 73.9years; range 33–92; 8 males) were included; 8/15 (53%) had at least one previous endothelial graft and 4/15 had combined PK–DSAEK or PK–DMEK. Advanced glaucoma with trabeculectomy or tubes, aniridia, prior retinal detachment surgery or maculopathy were present in 11/15 (73%) eyes. Mean baseline pachymetry was approximately 930µm (range 520–3430µm), improving to a mean of 640µm at the latest measurement. Baseline vision was HM or CF in 12/15 (80%) eyes, improving to 6/24–6/12 in 5/15 (33%) eyes, mainly FED, pseudophakic bullous keratopathy or disciform keratitis cases. One eye (7%) required resuturing, two (13%) required rebubbling, and no eye developed new sustained IOP elevation.​

In this 15‑eye high‑risk cohort, EndoArt achieved substantial corneal deturgescence with one‑third of eyes gaining BCDVA of at least 6/24 despite advanced comorbidity. The low rates of rebubbling, resuturing and IOP‑related complications support EndoArt as a promising keratoplasty‑sparing option in endothelial failure after graft or tube surgery.