Corneal Endothelial Cell Loss From Anterior Chamber Paracentesis in a Porcine Model.

Abstract

This study aimed to develop a porcine eye model used to predict corneal endothelial cell loss (ECL) associated with anterior chamber paracentesis (ACP) in a healthy adult human cornea. To assess the average wound area and ECL created by needle punctures, a 27-gauge (27G) needle was inserted at the limbus of a porcine eye through the clear cornea and into the anterior chamber. Needle-punctured areas were immediately collected, stained, and photographed with a digital light microscope. The wound areas were quantified in square millimeters (mm) and then extrapolated to predict ECL in a healthy adult human cornea. The average wound area of the puncture sites was 0.274 ± 0.122 mm. The needle punctures created a larger area of ECL than the observed cross-sectional area of the needle (0.12 mm). Extrapolating these data to the ECL that would occur in healthy adult human corneas, each 27G corneal needle puncture would damage 685 cells, or 0.21% of the corneal endothelial cell layer. The predicted wound areas for 28G, 30G, and 33G needles were 0.234 mm, 0.163 mm, and 0.072 mm, respectively. The predicted cell loss for a 28G, 30G, and 33G needle stick corresponded to a loss of 586 cells (0.18% of the corneal endothelium), 407 cells (0.13% of the corneal endothelium), and 181 cells (0.06% of the corneal endothelium), respectively. Frequent ACPs following intravitreal injections may be associated with clinically significant ECL; thus, caution is advised, particularly in patients with compromised corneas and low endothelial cell counts.