{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T07:46:32Z","timestamp":1782200792418,"version":"3.54.5"},"reference-count":43,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,20]],"date-time":"2026-06-20T00:00:00Z","timestamp":1781913600000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100013400","name":"American Academy of Optometry Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013400","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018313","name":"Cleveland Eye Bank Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018313","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["OVS"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Substantial endothelial cell loss (\u223c80%) occurs after keratoplasty. Corneal rigid and scleral lenses are frequently prescribed to manage irregular astigmatism and high refractive error, but lens wear may contribute to hypoxic stress. The relationship between various lens wear and corneal stress after penetrating keratoplasty remains unclear. This study characterizes cell density distribution in post\u2010keratoplasty corneas and evaluates its influence on swelling during lens wear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants \u22655\u00a0years post\u2010surgery, with or without habitual lens wear, were enrolled. Specular microscopy measured endothelial cell density in central, superior, inferior, superotemporal, and superonasal corneal quadrants (@3\u00a0mm). Baseline corneal thickness maps (&gt;2\u00a0h after waking without lens wear) were acquired using Scheimpflug imaging (Pentacam). Wearers applied habitual lenses and all participants returned 6\u20138\u00a0h later for imaging. Nonparametric tests assessed cell density variation by quadrant and lens designs. Linear mixed models evaluated associations between endothelial parameters and corneal swelling while accounting for within\u2010subject correlation, repeated measures, lens type, location, and interactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010five participants (31 eyes) from three centers were included; 90% had keratoconus preoperatively. Four wore large\u2010diameter scleral lenses (13%), nine wore small\u2010diameter scleral lenses (29%), 12 wore corneal rigid lenses (39%), and six did not wear lenses (19%). Cell density across quadrants averaged 780\u00a0\u00b1\u00a0240 cells\/mm\n                      <jats:sup>2<\/jats:sup>\n                      . Central thickness decreased slightly in non\u2010lens\u2010wearing eyes (\u22120.3%) but increased in lens\u2010wearing eyes (1.9%\u00a0\u00b1\u00a03.1%). Central cell density showed a weak negative correlation with swelling (\n                      <jats:italic>r<\/jats:italic>\n                      \u00a0=\u00a0\u22120.39,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.03). Compared with non\u2010lens wearers, corneal rigid (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.02) and large diameter scleral lenses (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.05) generated greater swelling; smaller diameter scleral lenses did not.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although all eyes fitted with various lens designs were clear, lower central cell density correlated with increased swelling during lens wear, except when smaller diameter scleral lenses were worn. Clinically, however, cell density does not seem to be a robust predictor of corneal swelling induced by lens wear post\u2010keratoplasty.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ovs2.70080","type":"journal-article","created":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T02:24:09Z","timestamp":1782008649000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Influence of corneal endothelial cell density after penetrating keratoplasty on contact lens induced corneal swelling"],"prefix":"10.1002","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5452-1811","authenticated-orcid":false,"given":"Loretta","family":"Szczotka\u2010Flynn","sequence":"first","affiliation":[{"name":"Case Western Reserve University (CWRU) Department of Ophthalmology &amp; Visual Sciences and University Hospitals Eye Institute University Hospitals of Cleveland  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5786-6089","authenticated-orcid":false,"given":"Muriel","family":"Schornack","sequence":"additional","affiliation":[{"name":"Mayo Clinic Department of Ophthalmology  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4790-7972","authenticated-orcid":false,"given":"Beth Ann","family":"Benetz","sequence":"additional","affiliation":[{"name":"Case Western Reserve University (CWRU) Department of Ophthalmology &amp; Visual Sciences and University Hospitals Eye Institute University Hospitals of Cleveland  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengxi","family":"Chen","sequence":"additional","affiliation":[{"name":"CWRU Department of Population and Quantitative Health Sciences  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7730-3921","authenticated-orcid":false,"given":"Jaskirat","family":"Takhar","sequence":"additional","affiliation":[{"name":"Prism Eye Institute  Mississauga Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Indiana University School of Optometry  Bloomington Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1048-3408","authenticated-orcid":false,"given":"Christine","family":"Sindt","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"McMahon","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University of Illinois at Chicago  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9101-4381","authenticated-orcid":false,"given":"Holly","family":"Hartman","sequence":"additional","affiliation":[{"name":"CWRU Department of Population and Quantitative Health Sciences  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0192-7487","authenticated-orcid":false,"given":"Langis","family":"Michaud","sequence":"additional","affiliation":[{"name":"\u00c9cole d'optom\u00e9trie de l\u2019Universit\u00e9 de Montr\u00e9al  Montreal Qu\u00e9bec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2019.02.011"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/1389486"},{"key":"e_1_2_9_4_1","first-page":"218","article-title":"Corneal swelling response to contact lenses worn under extended wear conditions","volume":"24","author":"Holden BA","year":"1983","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"e_1_2_9_5_1","first-page":"211","article-title":"Overnight swelling of the living human cornea","volume":"51","author":"Mertz GW","year":"1980","journal-title":"J Am Optom Assoc"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2013.08.044"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1888\u20104296(10)70022\u20104"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2018.05.004"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/opx.0000000000001245"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/icl.0000000000000610"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/opx.0000000000001571"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/icl.0000000000000163"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfo.2014.10.018"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2014.10.001"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2013.11.001"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/opx.0000000000000018"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.icl.0000233217.68379.d5"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003226\u2010200305000\u201000006"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/112067219600600101"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0161\u20106420(93)31410\u20107"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0002\u20109394(14)73521\u20104"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijo.ijo_2394_24"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.14\u201014038"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004397\u2010196800830\u201000009"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2012.07.004"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/02713683.2018.1500610"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0000000000001558"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2020.08.002"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2014.09.008"},{"key":"e_1_2_9_30_1","first-page":"5","article-title":"The effect of corneal edema on visual function","volume":"16","author":"Hess RF","year":"1977","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003226\u2010200001000\u201000010"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/ico.0000000000000120"},{"key":"e_1_2_9_33_1","article-title":"Preventing and managing edema with scleral lenses","author":"Fadel D","year":"2023","journal-title":"Rev Cornea Cont Lens"},{"key":"e_1_2_9_34_1","volume-title":"A guide to scleral lens fitting: College of Optometry","author":"Van der Worp E","year":"2010"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2008.01.004"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clae.2017.03.003"},{"key":"e_1_2_9_37_1","first-page":"130","volume-title":"Cornea: fundamentals, diagnosis, management","author":"Benetz BA","year":"2021"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1080\/02713680500536738"},{"key":"e_1_2_9_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/icl.0000000000000382"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/coa.0000000000000061"},{"key":"e_1_2_9_41_1","article-title":"Decreased clearance between scleral contact lens and cornea after 2 hours of lens wear","volume":"54","author":"Nau C","year":"2013","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.4103\/0971\u20105916.180210"},{"key":"e_1_2_9_44_1","first-page":"3116","article-title":"Sympathetic swelling response of the control eye to soft lenses in the other eye","volume":"40","author":"Fonn D","year":"1999","journal-title":"Invest Ophthalmol Vis Sci"}],"container-title":["Optometry and Vision Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ovs2.70080","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ovs2.70080","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ovs2.70080","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T06:49:49Z","timestamp":1782197389000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ovs2.70080"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":43,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/ovs2.70080"],"URL":"https:\/\/doi.org\/10.1002\/ovs2.70080","archive":["Portico"],"relation":{},"ISSN":["1040-5488","1538-9235"],"issn-type":[{"value":"1040-5488","type":"print"},{"value":"1538-9235","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-02-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70080"}}