Influence of Posterior Corneal Surface Irregularities on the Attachment of an Artificial Endothelial Layer (EndoART).

Purpose: This study aimed to refine the criteria for EndoART implantation regarding posterior corneal irregularity; to improve the selection of candidates for this synthetic alternative to endothelial keratoplasty. Methods: This study analyzed the impact of posterior corneal surface elevation differences; anterior chamber depth (ACD); and preoperative corneal pachymetry on the success of EndoART implant adhesion. Patients undergoing EndoART implantation at the Medical University of Vienna were assessed using OCT to measure corneal irregularities. Postoperative outcomes, including re-bubbling rates; implant adhesion; and visual acuity changes, were monitored. Results: EndoART successfully adhered in eyes with moderate posterior irregularities (elevation differences up to 204 µm). Severe irregularities (elevation differences > 200 µm) resulted in implant detachment. No significant correlation was found between corneal pachymetry or ACD and adhesion failure. Glaucoma devices and prior penetrating keratoplasty did not significantly affect adhesion. Some cases required re-bubbling, and patients reported pain reduction and moderate improvements in visual acuity. Conclusions: This study found that EndoART implantation can be successful despite posterior corneal irregularity. EndoART represents a viable solution for patients with poor biological graft survival prognosis, including those with glaucoma or prior surgeries, expanding its potential use and addressing the global donor cornea shortage.