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. 2010 Jan;128(1):63-9.
doi: 10.1001/archophthalmol.2010.128.63.

Endothelial cell density to predict endothelial graft failure after penetrating keratoplasty

Jonathan H Lass  1 , 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
Collaborators, Affiliations

Endothelial cell density to predict endothelial graft failure after penetrating keratoplasty

Jonathan H Lass et al. Arch Ophthalmol. 2010 Jan.

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).

Trial registration: ClinicalTrials.gov NCT00006411.

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Figures

Figure 1
Figure 1
Endothelial cell density (ECD) over time in graft failures from endothelial decompensation (n = 17) and in nonfailures (n = 483). In the box plots, black dots indicate mean values; horizontal lines in the boxes, medians; and the bottom and top of the boxes, the 25th and 75th percentiles. The horizontal lines outside the boxes represent the range of ECD values.
Figure 2
Figure 2
Cumulative incidence of graft failure from endothelial decompensation by endothelial cell density (ECD) at 6 months (n = 269); 231 participants were excluded, 1 for graft failure before 6 months’ follow-up, 5 were censored before or at 6 months’ follow-up, and 225 for missing 6-month ECD values. See the penultimate paragraph in the “Methods” section.
See this image and copyright information in PMC

References

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    1. Lass JH, Gal RL, Dontchev M, et al. Cornea Donor Study Investigator Group. Donor age and corneal endothelial cell loss 5 years after successful cornea transplantation: Specular Microscopy Ancillary Study results. Ophthalmology. 2008;115(4):627–632. e8. - PMC - PubMed
    1. Benetz BA, Gal RL, Ruedy KJ, et al. Cornea Donor Study Group. Specular Microscopy Ancillary Study methods for donor endothelial cell density determination of Cornea Donor Study images. Curr Eye Res. 2006;31(4):319–327. - PMC - PubMed
    1. Sugar A, Gal RL, Beck W, et al. Cornea Donor Study Group. Baseline donor characteristics in the Cornea Donor Study. Cornea. 2005;24(4):389–396. - PubMed
    1. Mannis MJ, Holland EJ, Beck RW, et al. Cornea Donor Study Group. Clinical profile and early surgical complications in the Cornea Donor Study. Cornea. 2006;25(2):164–170. - PubMed

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