title: Change of recipient corneal endothelial cells after non-descemet's stripping automated endothelial keratoplasty in a rabbit model.
abstract: OBJECTIVE
  We used a rabbit model to evaluate the interface embedded between the recipient corneas and transplanted donor corneal discs after non-Descemet's stripping automated endothelial keratoplasty (nDSAEK).
  
  
  METHODS
  Unilateral DSAEK and nDSAEK surgeries were performed on New Zealand white rabbits. In vivo confocal microscopy was performed to show: the changes in corneal endothelial cells embedded between the recipient corneas and the transplanted donor corneal discs (CEEB); and the interface opacity by z profile. Immunohistochemistry were performed to evaluate the functional change of CEEB at post-nDSAEK 3 months. Transmission electron microscopy was performed to evaluate the morphology of CEEB after nDSAEK at post-nDSAEK 1, 3, and 6 months.
  
  
  RESULTS
  In vivo confocal microscopy showed a time-dependent decrease in the density of CEEB at postoperative 1, 2, or 3 months (P < 0.01). Interface opacity was higher in the nDSAEK group than the DSAEK group at all examination points, but the difference was statistically insignificant. At 3 months after surgery, the CEEB were negative for Na(+)/K(+)-ATPase staining. Staining with TUNEL showed apoptotic changes in some areas. During a 6-month observation, the CEEB showed a time-dependent thickening and loss of uniform thickness of cellular morphology. At 3 and 6 months post nDSAEK, extensions of the cellular processes into the donor graft stroma combined with intracellular vacuoles containing collagen-like materials were also found.
  
  
  CONCLUSIONS
  After non-Descemet's stripping automated endothelial keratoplasty, the CEEB showed decreased density, loss of pump function, apoptosis and changed morphology. However, the interface opacity was not significantly greater compared with DSAEK eyes.
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jen-Pin
authors.initials: JP
authors.lastname: Sun
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Fung-Rong
authors.initials: FR
authors.lastname: Hu
authors.affiliation: Department of Ophthalmology, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
authors.forename: Yan-Ming
authors.initials: YM
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hsiao-Sang
authors.initials: HS
authors.lastname: Chu
authors.affiliation: Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan Center of Corneal Tissue Engineering and Stem Cell Biology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wei-Li
authors.initials: WL
authors.lastname: Chen
mesh_terms: D000818:Animals; D016039:Corneal Transplantation / Q000379:methods; D003886:Descemet Membrane / Q000648:ultrastructure*; D004195:Disease Models, Animal; D042783:Endothelial Cells / Q000473:pathology* / Q000648:ultrastructure; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation*; D005260:Female; D007150:Immunohistochemistry; D018613:Microscopy, Confocal; D046529:Microscopy, Electron, Transmission; D011817:Rabbits
keywords: DSAEK; corneal endothelial cells; in vivo confocal microscopy; nDSAEK; transmission electron microscopy