title: Very early endothelial cell loss after simultaneous corneal autograft and allograft.
abstract: OBJECTIVE
  For a better understanding of the very early endothelial cell (EC) loss universally described after all types of keratoplasty, we compared the EC decrease after performing a simultaneous autograft and organ-cultured allograft.
  
  
  METHODS
  A 71-year-old woman presented with a central corneal opacity in her left eye and a profoundly amblyopic right eye with a transparent cornea. Both corneas had a normal EC density (ECD). She underwent a left autograft and a right allograft procedure with an organ-cultured cornea, in which the ECD was determined using a calibrated light microscope with image analysis 48 hours before the surgery, that is, just before the final deswelling step with dextran. The postoperative central ECD was determined using specular microscopy on days (D) 1, 2, 3, 4, 5, 15, 20, 30, 60, 90, 120, and 180.
  
  
  RESULTS
  Both grafts were uneventful. For the autograft, the pregraft ECD was 2303 cells per square millimeter, and the cell loss was very low, from 4% (D1) to 3% (D180). For the allograft, the pregraft eye bank ECD was 2787, and this decreased by 32% on D5. On D180, the ECD decrease was almost stabilized at 38%.
  
  
  CONCLUSIONS
  This difference between the autograft and allograft, both performed in corneas with a normal peripheral endothelial reserve, indicates that the typical very early postoperative decrease in the EC is not caused mainly by surgery-dependent overmortality. It may be mostly artificial, revealing the overestimation of eye bank ECD caused by the technical unfeasibility of strictly considering living ECs and by measuring the ECD several days before grafting. This exceptional case suggests a new paradigm: surgeons graft fewer ECs than they think.
authors.affiliation: *Corneal Graft Biology, Engineering and Imaging Laboratory, Federative Institute of Research in Sciences and Health Engineering, Jean Monnet University, Saint-Etienne, France; †Department of Ophthalmology, University Hospital of Saint-Etienne, France; ‡Eye Bank of Saint-Etienne, Auvergne Loire Blood Center, Saint-Etienne, France; §Department of Pathology, University Hospital of Saint-Etienne, France; and ¶Institut Universitaire de France, Boulevard Saint-Michel, Paris, France.
authors.forename: Nelly
authors.initials: N
authors.lastname: Campolmi
authors.forename: Marie Caroline
authors.initials: MC
authors.lastname: Trone
authors.forename: Chaker
authors.initials: C
authors.lastname: Nefzaoui
authors.forename: Mansour
authors.initials: M
authors.lastname: Aldossary
authors.forename: Zhiguo
authors.initials: Z
authors.lastname: He
authors.forename: Sophie
authors.initials: S
authors.lastname: Acquart
authors.forename: Olivier
authors.initials: O
authors.lastname: Garraud
authors.forename: Fabien
authors.initials: F
authors.lastname: Forest
authors.forename: Michel
authors.initials: M
authors.lastname: Péoc'h
authors.forename: Gilles
authors.initials: G
authors.lastname: Thuret
authors.forename: Philippe
authors.initials: P
authors.lastname: Gain
mesh_terms: D000368:Aged; D064591:Allografts; D002452:Cell Count; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis / Q000209:etiology*; D003318:Corneal Opacity / Q000601:surgery*; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008853:Microscopy; D009924:Organ Culture Techniques; D018918:Phacoemulsification / Q000009:adverse effects*; D014019:Tissue Donors; D014182:Transplantation, Autologous