Endothelial cell density to predict endothelial graft failure after penetrating keratoplasty.

Abstract

OBJECTIVE:

To determine whether preoperative and/or postoperative central endothelial cell density (ECD) and its rate of decline postoperatively are predictive of graft failure caused by endothelial decompensation following penetrating keratoplasty to treat a moderate-risk condition, principally, Fuchs dystrophy or pseudophakic corneal edema.

METHODS:

In a subset of Cornea Donor Study participants, a central reading center determined preoperative and postoperative ECD from available specular images for 17 grafts that failed because of endothelial decompensation and 483 grafts that did not fail.

RESULTS:

Preoperative ECD was not predictive of graft failure caused by endothelial decompensation (P = .91). However, the 6-month ECD was predictive of subsequent failure (P < .001). Among those that had not failed within the first 6 months, the 5-year cumulative incidence (+/-95% confidence interval) of failure was 13% (+/-12%) for the 33 participants with a 6-month ECD of less than 1700 cells/mm(2) vs 2% (+/-3%) for the 137 participants with a 6-month ECD of 2500 cells/mm(2) or higher. After 5 years' follow-up, 40 of 277 participants (14%) with a clear graft had an ECD below 500 cells/mm(2).

CONCLUSIONS:

Preoperative ECD is unrelated to graft failure from endothelial decompensation, whereas there is a strong correlation of ECD at 6 months with graft failure from endothelial decompensation. A graft can remain clear after 5 years even when the ECD is below 500 cells/mm(2).

• Authors: Jonathan H Lass, Alan Sugar, Beth Ann Benetz, Roy W Beck, Mariya Dontchev, Robin L Gal, Craig Kollman, Robert Gross, Ellen Heck, Edward J Holland, Mark J Mannis, Irving Raber, Walter Stark, R Doyle Stulting, Cornea Donor Study Investigator Group
• Journal: Archives of ophthalmology (Chicago, Ill. : 1960) (Arch Ophthalmol) Vol. 128 Issue 1 Pg. 63-9 (Jan 2010) ISSN: 1538-3601 [Electronic] United States
• PMID: 20065219 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Age Factors
• Aged
• Cell Count
• Child
• Corneal Edema (complications)
• Endothelium, Corneal (pathology)
• Female
• Fuchs' Endothelial Dystrophy (complications)
• Graft Rejection (diagnosis, etiology)
• Humans
• Keratoplasty, Penetrating
• Male
• Middle Aged
• Postoperative Period
• Preoperative Period
• Tissue Donors