Endothelial keratoplasty: The relationship between recipient anterior chamber depth and endothelial cell loss

PURPOSE: To determine the relationship between anterior chamber depth (ACD) and percent endothelial cell loss (ECL) after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). METHOD: In 78 eyes receiving triple procedure (DSAEK combined with cataract extraction and posterior chamber intraocular lens (PCIOL) implantation), ACD was measured preoperatively with an intraocular lens (IOL) Master and ECL was calculated with specular microscopy at 6 months, 1, 2, 3, and 4 years postoperatively. ACD and ECL from all 78 eyes were compared using correlation analysis and students t test. Eyes were then separated into 2 groups based on ACD, group 1 with ACD < 3mm and group 2 with ACD ≥ 3mm. Students t test was then performed to compare group 1 and group 2 ECL at 6 months, 1, 2, 3, and 4 years postoperative. RESULTS: Mean ACD for all 78 eyes was 2.93 ± 0.43 mm. Mean ECL was 32.7%, 27.6%, 29.6%, 32.5%, and 37.2% at 6 months, 1, 2, 3, and 4 years. No significant correlation between ACD and ECL was observed at any time point for the combined analysis of 78 eyes (P > .05). At 2 and 4 years postoperative, mean ECL was 32.6% ± 16.1% and 43.0% ± 23.2% in eyes with ACD < 3mm and 25.3% ± 13.0% and 29.6% ± 18.2% in eyes with ACD ≥ 3 mm (P = .041 at 2 years and .008 at 4 years). CONCLUSION: ACD and ECL were not directly correlated; however, there may be a threshold ACD in which shallower anterior chambers preoperatively result in greater donor ECL over time.