Evidence of endothelial cell migration after descemet membrane endothelial keratoplasty

Purpose: To investigate the hypothesis that adult corneal endothelial cells can migrate after Descemet membrane endothelial keratoplasty (DMEK).

Design: Prospective observational study.

Methods: Five patients with Fuchs endothelial dystrophy were examined 1 year after uneventful DMEK. These patients had been selected on the basis of slightly decentered grafts and/or large descemetorrhexis showing areas of denuded corneal stroma, which were covered by neither the patients' Descemet membrane (DM) nor the graft. These areas were investigated by in vivo confocal laser scanning microscopy using a specially designed Heidelberg Retina Tomograph II and Rostock cornea module equipped with custom-made software. Source data (frame rate 30 Hz, 384 × 384 pixels, 400 × 400 μm) were used to create large-scale maps of the scanned area in automatic real-time composite mode. In each case an on-line mapping with maximum size up to 3.2 × 3.2 mm (3072 × 3072 pixels) was performed.

Results: Corneal stroma overlying areas devoid of DM was transparent. In vivo confocal laser scanning microscopy of stroma devoid of DM revealed a monolayer of endothelial cells in all patients observed. The morphologic pattern of these cells was similar to that of endothelial cells on DM grafts but different from the morphology of the patients' own endothelium, suggesting migration of donor endothelial cells from DMEK grafts.

Conclusions: The results strongly support the hypothesis that adult corneal endothelial cells are able to migrate in the human eye. Furthermore, we provide evidence to support the hypothesis that grafted endothelium migrates onto the host tissue, repopulating the corneal stroma with a regular endothelial phenotype.