The corneal endothelium appears to be of primary importance in maintaining the normal dehydration of the cornea and its clarity. In keratoplasty it has become clear that almost the full thickness of the cornea can be removed in a lamellar keratoplasty, and that this can be replaced by dead preserved tissue. This dead tissue retains its clarity and permits a perfectly useful visual result. When keratoplasty includes the endothelium, however, the donor endothelium must be alive and healthy for the cornea to remain dehydrated. Damage to the endothelium or death of donor endothelial cells can be expected to reduce the likelihood of a favorable result after penetrating keratoplasty.
Although the endothelium has been examined by various staining techniques, the use of histochemical stains for cellular enzymes permits not only visualization of the corneal endothelium, but also some appraisal of its metabolic normality.1 With this technique it is possible to
ROBBINS JE, CAPELLA JA, KAUFMAN HE. A Study of Endothelium in Keratoplasty and Corneal Preservation. Arch Ophthalmol. 1965;73(2):242-247. doi:10.1001/archopht.1965.00970030244018