Effects of penetrating keratoplasty rejection on the endothelium of the donor cornea and the recipient peripheral cornea

Abstract PURPOSE: To determine the effects of penetrating keratoplasty rejection on the recipient endothelium. METHODS: Twenty transplanted corneas of 20 keratoconus patients were enrolled in this study. Ten of the corneas had undergone allograft rejection and the other 10 grafts had an uneventful postsurgical course. The endothelium of the donor cornea and the endothelium of the recipient peripheral cornea were evaluated by wide-field specular microscopy. RESULTS: The transplanted corneas that underwent allograft rejection showed a marked decrease in endothelial cell density not only in central donor cornea but also in the recipient peripheral cornea compared with that in the uneventful transplanted corneas. Additionally, the recipient endothelium had significant pleomorphism in the rejection group. There were no morphologic differences in the peripheral donor cornea between the control group and the rejection group. CONCLUSIONS: Our findings indicate that the recipient peripheral endothelium is also affected by allograft rejection, perhaps because of the contribution of recipient endothelium to the wound healing process after allograft rejection.