Baseline factors related to endothelial cell loss following penetrating keratoplasty

Abstract

Objective: To identify baseline (donor, recipient, and operative) factors that affect endothelial cell loss following penetrating keratoplasty for a moderate-risk condition (principally Fuchs dystrophy or pseudophakic or aphakic corneal edema).

Methods: In a subset (n = 567) of Cornea Donor Study participants, preoperative and postoperative endothelial cell densities (ECDs) were determined by a central reading center. Multivariate regression analyses were performed to examine which baseline factors correlated with ECD over time.

Results: Larger grafts (P < .001), younger donor age (P < .001), and female donor (P = .004) were significantly associated with higher ECD during follow-up. Median endothelial cell loss at 5 years was 68% for grafts larger than 8.0 to 9.0 mm in diameter, 75% for grafts 7.0 mm to smaller than 8.0 mm in diameter, and 74% for grafts 8.0 mm in diameter. Grafts from female donors experienced a 67% cell loss compared with a 72% cell loss among grafts from male donors. Method of tissue retrieval, donor cause of death, history of diabetes, and time from death to preservation or to surgery were not significantly associated with changes in ECD over time.

Conclusions: Following penetrating keratoplasty for endothelial dysfunction conditions, larger donor graft size, younger donor age, and female donor were associated with higher ECD over 5 years. These data warrant exploring the possibility that similar associations may exist following endothelial keratoplasty.

Trial registration: clinicaltrials.gov Identifier: NCT00006411.

Figure 1

Endothelial cell density change over time. A: Includes all subjects that have at least one gradable postoperative image before either the date of graft failure or the end of 5-year follow up available (n=567), B: Restricted to subjects without graft failure at 5 years (n=345). Black dots indicate mean values; horizontal lines in the boxes, medians; and the bottom and top of the boxes, the 25^th and 75^th percentiles, respectively.

Figure 2

Endothelial cell density over time according to donor gender. Black dots indicate mean values; horizontal lines in the boxes, medians; and the bottom and top of the boxes, the 25^th and 75^th percentiles, respectively.