An evaluation of image quality and accuracy of eye bank measurement of donor cornea endothelial cell density in the Specular Microscopy Ancillary Study

Purpose To assess 3-year outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in comparison with penetrating keratoplasty (PKP) from the Cornea Donor Study (CDS). Design Prospective, multicenter, nonrandomized clinical trial. Participants A total of 173 subjects undergoing DSAEK for a moderate risk condition (principally Fuchs’ dystrophy or pseudophakic corneal edema) compared with 1101 subjects undergoing PKP from the CDS. Methods The DSAEK procedures were performed by two experienced surgeons using the same donor and similar recipient criteria as for the CDS PKP procedures, performed by 68 surgeons. Graft success was assessed by Kaplan Meier survival analysis. Central endothelial cell density (ECD) was determined from baseline donor and postoperative central endothelial images by the reading center used in the CDS Specular Microscopy Ancillary Study. Main Outcome Measures Graft clarity and endothelial cell density Results The donor and recipient demographics were comparable in the DSAEK and PKP groups, except the proportion of Fuchs’ dystrophy cases was higher in the DSAEK cohort. The 3-year survival rate did not differ significantly between DSAEK and PKP procedures performed for either Fuchs’ dystrophy (96% for both, P=0.81) or non-Fuchs cases (86% vs. 84%, respectively, P=0.41). Principal causes of graft failure/regraft within 3 years after DSAEK and PKP were immunologic graft rejection (0.6% vs. 3.1%), endothelial decompensation in the absence of documented rejection (1.7% vs 2.1%), unsatisfactory visual or refractive outcome (1.7% vs. 0.5%), and infection (0% vs. 1.1%), respectively. The 3-year predicted probability of a rejection episode was 9% with DSAEK vs. 20% with PKP (P=0.0005). The median 3-year cell loss for DSAEK and PKP was 46% and 51%, respectively (P=0.33) in Fuchs’s dystrophy cases, and 59% and 61%, respectively (P=0.70), in the non-Fuchs’ cases. At 3 years, use of a smaller DSAEK insertion incision was associated with significantly higher cell loss (60% vs. 33% for 3.2- and 5.0-mm incisions, respectively, P=0.0007) but not a significant difference in graft survival (P=0.45). Conclusions The graft success rate and endothelial cell loss were comparable at 3 years for DSAEK and PKP procedures. A 5-mm DSAEK incision width was associated with significantly less cell loss than a 3.2-mm incision.

show abstract

“…2,7 The endothelial cell loss and graft survival rate through 5-years were previously reported for the CDS and SMAS cohorts. 2,4,7,8 …”

Section: Methodsmentioning

confidence: 99%

Descemet's Stripping Automated Endothelial Keratoplasty

Price¹,

Gorovoy²,

Price³

et al. 2013

Ophthalmology

144

View full text Add to dashboard Cite

show abstract

“…The preoperative donor images and postoperative subject images were evaluated for quality and ECD by a central reading center, the Cornea Image Analysis Reading Center or CIARC (formerly the Specular Microscopy Reading Center or SMRC) at Case Western Reserve University and University Hospitals Eye Institute, using a previously described variable frame analysis method. 6, 8-10 If the independent ECD determinations of two readers differed by > 5.0%, a third determination of ECD was made by an independent adjudicator. 8 …”

Section: Methodsmentioning

confidence: 99%

Baseline Factors Related to Endothelial Cell Loss Following Penetrating Keratoplasty

et al. 2011

View full text Add to dashboard Cite

“…Due to the quality limitations of the donor images, 5 the majority could not be analyzed by the corners method, thus the center method was chosen for analysis of the entire donor image set for this study.…”

Section: Methodsmentioning

confidence: 99%

“…Endothelial cell density (ECD) also was assessed in a subset of subjects in an ancillary study of the CDS, the Specular Microscopy Ancillary Study (SMAS) 5, 6 to examine its relationship with these same donor and recipient factors. A slight association between increasing donor age and greater post-PKP corneal endothelial cell loss by 5 years was found among eyes whose grafts were successful at five years.…”

Section: Introductionmentioning

confidence: 99%