Sir,

A healthy corneal endothelial cell count is vital for corneal clarity. The corneal endothelial cell density is known to decrease with age in normal populations. Corneal endothelial cell densities are important considering suitable corneal buttons for penetrating keratoplasties. These densities may also prove useful in identifying populations at risk of developing corneal decompensation following cataract extraction by phacoemulsification.

We collected data, by prospective data collection, from a Pakistani Punjabi population presenting in our outpatients department, with complaints ranging from decreased vision due to cataracts, refractive errors, and other pathological conditions unrelated to the anterior segment. Patients with corneal pathologies, dystrophies, dry eye states, ocular trauma, ocular surgery, contact lens wear, glaucoma or increased IOP, uveitis, and diabetes were excluded.

A total of 450 eyes of 225 Pakistani volunteer patients were included aged between 20 and 70 years and of both sexes. The mean age of the patients was 45.4 years. In all, 118 males and 107 females were included. Corneal endothelial cell densities were counted on Konan Non Con Robo SP6000 specular microscope by fixed frame method (Figure 1).

Figure 1
figure 1

Endothelial cell count (fixed frame method).

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On average, our results showed a mean endothelial cell count of 2654±341/mm2 (1SD), with a range of 1960–3691 endothelial cells/mm2. Detailed results are shown in Table 1.The breakdown of mean endothelial cell density by age clearly shows decreasing cell counts with increasing age (Figure 2). We compare the endothelial cell counts in our population to those previously published in the literature (Table 1).

Table 1 Results and number of eyes involved compared to previously published studies of Rao et al and Matsuda et al
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Figure 2
figure 2

Graph showing decreased endothelial cell counts with increasing age in our patients.

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Discussion

Age-related changes in the density of the human corneal endothelium are well described in literature.1, 2 Our figures for the corneal endothelial cell counts in a Pakistani Punjabi population closely resemble Indian and Caucasian eyes but show significant differences when compared to Japanese eyes.3 However, the data published by Matsuda et al4 considers smaller number of eyes when compared to the other two quoted figures.

The strength of our series is the large number of patients with apparently healthy corneas, prospective data collection, and relatively large number of patients in each patient subgroup.

These endothelial cell counts are significant as they identify potential healthy corneal graft donors in our population. These populations would be expected to have the same risks of developing corneal decompensation as Caucasian and Indian populations, following cataract extraction by phacoemulsification.

Our figures show that Pakistani Punjabis may be potential donors of corneas with good endothelial counts. Punjabi populations in Pakistan and Asian British populations belonging to the same ethnic backgrounds in England may be expected to have similar patterns of corneal endothelial cell density as shown by our small study.

Encouraging more organ donations in the UK and abroad from these populations may mean significant work.5 Significant changes in opinion in these populations would be needed to encourage more organ donations. Attitudes and perceptions may limit the potential of organ harvesting for transplant surgery especially in ethnic minority groups.6 Pakistani Muslims generally have adverse feelings towards organ donation.7 This has its roots in tradition and partly in personal interpretations of religion. Religious scholars from the south Asia (Indo-Pak regions) have diverse views on this topic, which may have an impact on organ donation decisions by potential donors. However, most Islamic scholars favour organ transplantation including corneal transplant surgery.8 Organ donation would be considered a matter of personal interpretation of religion and choice of individuals. This is an issue, which needs tactful approach, when counselling for potential organ donation in ethnic minority groups.