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Evaluation of Endothelial Pump Function in Fuchs Endothelial Dystrophy Before and After Endothelial Keratoplasty

Purpose: To evaluate the endothelial pump function in vivo after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: In a prospective controlled trial, a group of 17 patients with Fuchs endothelial corneal dystrophy (FECD) eligible for DSAEK surgery and a group of 15 patients with cataract but with normal corneas eligible for cataract surgery (controls) were formed. A low oxygen-permeable contact lens was used to induce corneal edema. Changes in central corneal thickness were monitored as an indirect measure of endothelial cell pump function. Experiments were performed before surgery and repeated 12 months after surgery. Results: Comparing the FECD and control groups before surgery, there was 24.8% (13.5–36.1) more edema in the FECD group after 2 hours (P < 0.001) and 19.9% (8.6–31.3) more edema in the FECD group after 3 hours (P < 0.001). In the FECD group, there was 15% (3.1–26.9) less edema after DSAEK than before surgery (P = 0.015) after 3 hours. Comparing the DSAEK-treated eyes with the control eyes 12 months after surgery; there was 12.8% (3.5–22.1) more edema in the DSAEK group after 2 hours (P = 0.007), but after 3 hours, the percentages of edema were similar (P = 0.11). Conclusions: Twelve months after DSAEK surgery, the grafted endothelium cleared the induced edema as fast as the control group, indicating a viable and near-normal endothelial pump function. However, significant differences in the deswelling patterns were detected, which may be caused by the added corneal stroma after DSAEK.