Surgeon's Impact on Graft Endothelial Cell Density and Corneal Thickness after Penetrating Keratoplasty for Keratoconus and Fuchs' Dystrophy

Purpose: The aim of this study was to examine the short-and long-term variability of graft endothelial cell density (ECD) and central corneal thickness (CCT) after penetrating keratoplasty (PKP) between different surgeons. Patients and Methods: 370 eyes with keratoconus (KC) or Fuchs' dystrophy (FUCHS) after standardised primary excimer laser PKP (four experienced surgeons) were analysed. ECD and CCT were determined at 12 months after PKP before suture removal, and at two years after final suture removal. Results: 12 months after PKP, ECD was significantly higher for surgeon 1 in FUCHS as compared to surgeons 3 (p = 0.05) and 4 (p = 0.04), in KC it was significantly higher for surgeon 1 as compared to surgeon 2 (p = 0.001) and for surgeon 1 as compared to surgeon 4 (p = 0.006). However, in FUCHS this difference was no longer significant two years after suture removal (p > 0.5), and in KK only in comparison of surgeons 1 and 2 (p = 0.04). Results concerning CCT were inhomogeneous. Conclusions: The surgeon's individual handwriting seems to have an impact on the ECD in the short-term after PKP. However, differences between surgeons tend to become insignificant in the long run after suture removal.