We are surprised that in the important study by Wilhelmus et al,1 the corneal involvement in pseudoexfoliation syndrome is not mentioned. In view of the reduced endothelial count,2,3 the evidence of direct involvement of the individual corneal endothelial cells by local production of this peculiar extracellular matrix material,4,5 and the observation of corneal endothelial decompensation in the sense of "pseudoexfoliation keratopathy,"6 this would be of interest in the discussion of primary corneal graft failure. In addition, there is a possibility that pseudoexfoliation syndrome might be transferred through corneal transplantation to relatively young patients with keratoconus.7 In view of these clinical and laboratory findings, we believe that the health of the donor eye has a substantial impact on the potential success of a graft, and that intraocular and systemic conditions such as pseudoexfoliation syndrome should be specifically looked for in all eyes yielding donor corneas.
Naumann GOH, Küchle M. Primary Corneal Graft Failure. Arch Ophthalmol. 1996;114(8):1031. doi:10.1001/archopht.1996.01100140239040