Reduction of endothelial cell loss during phakic penetrating keratoplasty.

I studied the central donor endothelium of 30 clear, penetrating corneal transplants with a specular microscope before and within one week after keratoplasty. The mean endothelial cell loss was 15.6%, and there was no significant difference between the cell loss in phakic and aphakic transplants, as there had been in a previous study. Probably the decrease in endothelial cell loss in the phakic transplants was the result of the use of preoperative digital ocular massage, which softens the eye and decreases endothelial contact by recipient iris and lens during initial graft placement. The decreased use of a double scleral ring without preoperative massage also helped lower the cell loss. The postoperative corneal thickness, which was greater in aphakic transplants, also was significantly correlated with endothelial cell loss.