Purpose of Review: To review the clinical factors for endothelial cell density (ECD) loss and graft failure after corneal transplantation. Recent Findings: Reduction of ECD after corneal transplantation is associated with various clinical factors, such as the presence of glaucoma, graft diameter, donor age, donor diabetes, and donor gender. Recently, we reported the severe preexisting iris damage was one of the clinical factors for rapid ECD loss and graft failure. We also showed that preexisting iris damage causes chronic elevation of cytokine levels in the aqueous humor (AqH). Furthermore, the higher preoperative levels of specific cytokines in the AqH were associated with a rapid reduction in ECD after penetrating keratoplasty and endothelial keratoplasty. Summary: Iris damage and preoperative cytokine levels in the AqH can be potential biomarkers for the reduction of ECD after corneal transplantation, although we need to substantiate the exact mechanism of the endothelial cell loss.
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