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Corneal Innervation and Cellular Changes after Corneal Transplantation: An In Vivo Confocal Microscopy Study

From the Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.

PURPOSE. Although penetrating keratoplasty is generally considered a successful procedure, transplanted corneal tissue may exhibit abnormal epithelium, decreased sensation, and declining endothelial cell counts after surgery. This study aimed to use in vivo confocal microscopy to correlate corneal microstructure and recovery of the subbasal nerve plexus of the transplanted cornea with indications for, and time from, surgery.

METHODS. This was a cross-sectional study comparing corneas from 42 patients after penetrating keratoplasty with those of 30 controls. Subjects were assessed by ophthalmic history and clinical examination, computerized corneal topography, and laser scanning in vivo confocal microscopy.

RESULTS. Time from surgery ranged from 1 month to 40 years (mean, 85 ± 105 months). Significant reductions in epithelial (P < 0.001), keratocyte (P < 0.001), and endothelial (P < 0.001) cell densities were noted in comparison with control corneas. Significant reductions in subbasal nerve fiber density (P < 0.001) and nerve branching (P < 0.001) were also noted. Endothelial cell density decreased with time after surgery (r = –0.472; P = 0.003), and nerve fiber density (r = .328; P = 0.034) increased. Keratoconus as an indication for transplantation was associated with higher subbasal nerve fiber densities (P = 0.003) than other indications for corneal transplantation. Neither nerve fiber nor cell density was correlated with best-corrected visual acuity.

CONCLUSIONS. Laser scanning in vivo confocal microscopy highlights profound reductions in cell density at every level of the transplanted cornea and alterations to the subbasal plexus that are still apparent up to 40 years after penetrating keratoplasty.

This article has been cited by other articles:

				R. L. Niederer, D. Perumal, T. Sherwin, and C. N. J. McGhee Laser Scanning In Vivo Confocal Microscopy Reveals Reduced Innervation and Reduction in Cell Density in All Layers of the Keratoconic Cornea Invest. Ophthalmol. Vis. Sci., July 1, 2008; 49(7): 2964 - 2970. [Abstract] [Full Text] [PDF]

				S. V. Patel, J. C. Erie, J. W. McLaren, and W. M. Bourne Keratocyte Density and Recovery of Subbasal Nerves After Penetrating Keratoplasty and in Late Endothelial Failure Arch Ophthalmol, December 1, 2007; 125(12): 1693 - 1698. [Abstract] [Full Text] [PDF]

				R L Niederer, D Perumal, T Sherwin, and C N J McGhee Age-related differences in the normal human cornea: a laser scanning in vivo confocal microscopy study Br. J. Ophthalmol., September 1, 2007; 91(9): 1165 - 1169. [Abstract] [Full Text] [PDF]