Excessive Corneal Endothelial Single Cell Loss Following Endothelial Injuries

Corneal endothelial dysfunction is the main cause for more than 50% of corneal transplantations. Human corneal endothelial cells are generally viewed as non-proliferative in vivo. Any injury that results in endothelial loss exceeding the critical threshold can cause irreversible endothelial functional decompensation, leading to corneal edema and vision loss. Currently, the mainstay treatment for irreversible corneal dysfunction is corneal transplantation. In this work, using well-established imaging technique of specular microscopy, we revisited the endothelial damage following three common corneal endothelial injury scenarios: post-cataract surgery, endothelial dystrophy, and corneal penetrating injury. We identified unexpected, stochastic single-cell loss in the corneal endothelium following primary injuries, persisting well beyond the expected wound healing period, a phenomenon that has not been previously highlighted. This finding offers a potential explanation for the chronic endothelial cell loss following a primary injury. Further investigation could provide valuable insights for improving clinical management strategies for corneal endothelial dysfunction.