Scanning Electron Microscopy of Artificial Corneal Endothelial Keratoplasty implant

Purpose: To characterize the surface morphology and edge profile of fresh and explanted artificial corneal endothelial device (EndoArt ® ) using environmental scanning electron microscopy. Setting: Laboratory study. Design: High-resolution environmental scanning electron microscopy study. Methods: Two fresh and one explanted EndoArt ® specimens underwent examination using an environmental scanning electron microscope (EVO LS15, Carl Zeiss Meditec AG) with variable pressure chamber capabilities, enabling artifact-free examination of hydrophilic materials. Images were digitized at 2048 × 1760 dpi resolution with 200-micrometer scale markers. Both inner (corneal) and outer (aqueous) surfaces were evaluated at various magnifications, focusing on surface topography and edge profile characteristics. Results: The EndoArt ® device exhibited a dome-shaped configuration measuring 6.5 mm in diameter with uniform 50-micrometer thickness. Surface analysis revealed exceptionally smooth topographical characteristics on both surfaces without visible manufacturing marks, scratches, or polymeric irregularities. The tapered edge profile optimizes stable tissue adhesion with minimal mechanical trauma. Mirror-like surface quality exceeded that of conventional hydrophilic acrylic intraocular lenses. The explanted device demonstrated comparable morphology to fresh specimens, with fibres on the posterior (corneal-facing) surface consistent with corneal stromal collagen deposition, indicating biointegration rather than pathological fibrosis. Conclusions: The EndoArt ® device's superior surface characteristics and biocompatible acrylic composition support stable posterior corneal adhesion and biointegration while minimizing inflammatory complications. The posterior location (corneal surface facing) of fibrous attachments indicates favorable biointegration, contrasting with the anterior-surface fibrotic complications seen with solid keratoprostheses.