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• Is larger endothelial graft size appropriate for Fuchs endothelial dystrophy?
  Patrick J Chiam
  Published on: 22 March 2016

• Published on: 22 March 2016

  Is larger endothelial graft size appropriate for Fuchs endothelial dystrophy?

  • Patrick J Chiam, Corneal Fellow
  • Other Contributors:
    • Vijay Savant

  We read with interest the results reported by Romano et al. The authors speculated the reason for lower endothelial failure in larger grafts (9.5mm) compared to smaller ones is due to the additional endothelial cells being transplanted.

  It has been reported that the host peripheral endothelium in Fuchs endothelial dystrophy (FED) has some capacity towards restoring corneal deturgescence in denuded posterior st...

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  We read with interest the results reported by Romano et al. The authors speculated the reason for lower endothelial failure in larger grafts (9.5mm) compared to smaller ones is due to the additional endothelial cells being transplanted.

  It has been reported that the host peripheral endothelium in Fuchs endothelial dystrophy (FED) has some capacity towards restoring corneal deturgescence in denuded posterior stroma where the Descemet membrance endothalial keratoplasty (DMEK) did not attached.(1,2) This observation was seen in all 7 eyes with FED that had partial graft detachment but not in any of the 5 eyes with aphakic or pseudophakic bullous keratopathy (PBK).(1) In an eccentrically positioned DMEK, the area between the edge of the descemetorhexis and the edge of the graft often showed faster clearance in a fashion that starts from the recipient endothelium edge towards the graft.(2) In fact, this gap clears faster than the area over the attached DMEK.(2)

  The above findings suggest the peripheral endothelium in FED may have migrated to cover the bare posterior stroma. Interestingly, the peripheral endothelium may have regenerative capacity as the endothelium cell density (ECD) appeared similar in the repopulated area and in eyes with completed attached graft.(2)

  To accommodate a larger endothelial graft, the surgeon is likely to perform a larger descemetorhexis, hence removing more of the host's peripheral endothelium. Should some of latter remains, a large graft is likely to overlap hence damage the cells. Whether one should always aim to insert a larger graft in eyes with FED requires more thoughts.

  In their study, Romano et al mentioned that graft failure is associated with ECD and graft size. One wonders whether there is an association between failure with combined graft size and diagnosis (PBK/FED).

  1) Dirisamer M, Yeh RY, van Dijk K, Ham L, Dapena I, Melles GRJ. Recipient endothelium may relate to corneal clearance in Descemet membrane endothelial transfer. Am J Ophthalmol 2012; 154: 290-296. 2) Dirisamer M, Dapena I, Ham L, van Dijk K, Oganes O et al. Patterns of endothelialization and corneal clearance after Descemet membrane endothelial keratoplasty for Fuchs endothelial dystrophy. Am J Ophthalmol 2011; 152: 543-555.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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