Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty

Patel, Sanjay V.; Hodge, David O.; Bourne, William M.

doi:10.1016/j.ajo.2004.09.045

Cited by 226 publications

(182 citation statements)

References 14 publications

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“…Only donor corneas with an ECD of at least 2,000 cells/ mm 2 were suitable for PKP in our study. One of the researchers observed higher endothelial cell loss in grafts for keratoconus [45]; others reported higher ECD loss after PKP for Fuchs' dystrophy or corneal oedema [46,47]. Opposing studies, similar to our data, found no…”

Section: Financial Interestsupporting

confidence: 80%

Assessment of endothelial cell density and corneal thickness in corneal grafts an average of 5 years after penetrating keratoplasty

Kettesy

Németh

Kemény-Beke

et al. 2014

Wien Klin Wochenschr

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SummaryBackground Corneal transparency is a useful indicator for corneal function. Our aim was to investigate central corneal endothelial cells and corneal thickness in transplanted corneas at an average of 5.4 years after penetrating keratoplastyPatients and methods The study involved 68 perforated keratoplasty patients with at least a 1 year followup. Post-operatively, the central corneal endothelial layer was observed using a contact specular microscope. Central endothelial cell density, corneal thickness and the coefficient of variation of endothelial size were statistically analysed.Results The post-operative follow-up time was ranging from 12 months to 23 years. Endothelial cell density (ECD) was 1,501 ± 249 cell/mm 2 . The average cell size was 673.6 ± 98.3 μm 2 , and the coefficient of variation of cell size was 0.61 ± 0.11. No difference in ECD was detected between diagnostic groups. Corneal thickness was 0.56 ± 0.06 mm. Correlation between ECD and post-operative time was not significant (r = 0.02; p = 0.85).Conclusion Our study concluded that ECD showed a higher rate of decrease after penetrating keratoplasty with no relation to pre-operative diagnosis.Keywords Endothelial cell loss · graft survival · penetrating keratoplasty · specular microscope Bestimmung der Endothelzelldichte und der Hornhautdicke in Hornhauttransplantaten circa 5 Jahre nach einer penetrierenden Keratoplastik Zusammenfassung Hintergrund Die Transparenz der Cornea ist ein nütz-licher Indikator der Funktion der Hornhaut. Das Ziel unserer Studie war es, die zentralen Endothelzellen der Cornea sowie die Dicke der Hornhaut in transplantierten Hornhäuten circa 5,4 (im Durchschnitt) Jahre nach penetrierender Keratoplastik zu untersuchen.Patienten und Methoden In die Studie wurden 68 Patienten nach perforierter Keratoplastik aufgenommen, die zumindest 1 Jahr nachuntersucht worden waren. Postoperativ wurde die zentrale Endothelschicht der Hornhautmittel seines Kontakt-Spekular Mikroskops untersucht. Die Dichte der zentralen Endothelzellen, die Dicke der Hornhaut und der Variations-Koeffizient der Größe des Endothels wurden statistisch analysiert.Ergebnisse Der Zeitpunkt der postoperativen Kontrollen variierte von 12 Monaten bis 23 Jahren. Die Endothelzelldichte (EZD) lag bei 1501 ± 249 Zelle/mm 2 . Der Mittelwert der Zellgröße war 673,6 ± 98,3 μm 2 und der Variationskoeffizient 0,61 ± 0,11. Es gab keinen Unterschied in der EZD zwischen den nach Diagnosen eingeteilten Gruppen. Die Korrelation zwischen der EZD und dem Zeitabstand zur Operation war nicht kant (r = 0,02; p = 0,85).Schlussfolgerung Unsere Studie zeigt unabhängig von der präoperativen Diagnose eine abfallende Tendenz der EZD nach penetrierender Keratoplastik.

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Section: Financial Interestsupporting

confidence: 80%

Assessment of endothelial cell density and corneal thickness in corneal grafts an average of 5 years after penetrating keratoplasty

Kettesy

Németh

Kemény-Beke

et al. 2014

Wien Klin Wochenschr

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“…14 After 10 years of follow-up of 119 subjects from this same cohort, Ing et al 16 reported that younger donor age was associated with greater cell loss than older donor age, a finding that was still present after 15 years of follow-up. 8 This finding may have been due to the high graft failure rate among older donors, which might have biased the cell density results due to the loss of data from eyes with low ECD. There are also past studies suggesting that endothelial cell loss is higher after corneal transplantation with older donor tissue than after transplantation with younger donor tissue.…”

Section: Discussionmentioning

confidence: 69%

Donor Age and Corneal Endothelial Cell Loss 5 Years after Successful Corneal Transplantation

Jh¹,

Rl²,

Dontchev³

et al. 2008

Ophthalmology

169

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Objective-To determine whether endothelial cell loss 5 years after successful corneal transplantation is related to the age of the donor. Design-Multicenter, prospective, double-masked clinical trial.Participants-Three hundred forty-seven subjects participating in the Cornea Donor Study who had not experienced graft failure 5 years after corneal transplantation for a moderate-risk condition (principally Fuchs' dystrophy or pseudophakic corneal edema).Testing-Specular microscopic images of donor corneas obtained before surgery and postoperatively at 6 months, 12 months, and then annually through 5 years were submitted to a central reading center to measure endothelial cell density (ECD). Main Outcome Measure-Endothelial cell density at 5 years.Results-At 5 years, there was a substantial decrease in ECD from baseline for all donor ages. Subjects who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 69% in the study eye, resulting in a 5-year median ECD of 824 cells/mm 2 (interquartile range, 613-1342), whereas subjects who received a cornea from a donor 66 to 75 years old experienced a cell loss of 75%, resulting in a median 5-year ECD of 654 cells/mm 2 (interquartile range, 538-986) (P [adjusted for baseline ECD] = 0.04). Statistically, there was a weak negative association between ECD and donor age analyzed as a continuous variable (r [adjusted for baseline ECD] = −0.19; 95% confidence interval, −0.29 to −0.08).Conclusions-Endothelial cell loss is substantial in the 5 years after corneal transplantation. There is a slight association between cell loss and donor age. This finding emphasizes the importance of longer-term follow-up of this cohort to determine if this relationship affects graft survival.Corneal clarity after penetrating keratoplasty can be affected by endothelial cell loss over time. The exact cause of postoperative cell loss is unknown but may be a result of donor or preservation factors, surgical stress, cellular interactions between the donor and recipient, immune reaction, normal or accelerated cellular aging, or glaucoma. The Eye Bank Association of America requires endothelial cell density (ECD) determination via specular microscopy as a standard corneal tissue evaluation method but does not require a minimum cell density for transplant suitability. 1 Clinicians typically prefer donor corneas with a high pre-operative ECD in order to offset posttransplant cell loss under the belief that this will improve the probability of graft survival. Past studies evaluating endothelial cell loss after corneal transplantation have produced conflicting results with regard to the effect of donor age. Some studies suggest that there is no difference in endothelial cell loss comparing older and younger donor tissue, 2-5 whereas other studies suggest that there is a relationship between endothelial cell loss and donor age. 6 -8The Cornea Donor Study (CDS) has evaluated the effect of donor age on 5-year graft survival in eyes undergoing cornea transplantation for a corne...

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“…1 The causes of endothelial cell loss after corneal transplantation (PK or DALK) are numerous, including mechanical damage associated with the operation itself and later stage immune reactions that lead to rejection of the donor endothelial cells. An assessment of the endothelial cell density (ECD) is a commonplace method of pre-and post-operative monitoring of a corneal graft by using either specular microscopy [2][3][4][5][6][7][8] or, more recently, confocal microscopy. [9][10][11][12] Such high-resolution imaging of the corneal endothelium is generally needed to allow for endothelial cell counting and this is done, as it has long been recognised that a very low endothelial cell count may ultimately lead to reduced endothelial function and to subsequent graft failure.…”

Section: Introductionmentioning

confidence: 99%

In vivo confocal microscopy of the corneal endothelium: comparison of three morphometry methods after corneal transplantation

Jonuscheit

Doughty

Ramaesh

2011

Eye

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Purpose The purpose of this study was to assess the endothelium of corneal grafts by in vivo confocal microscopy (IVCM), and to evaluate an automated endothelial software system in comparison with a manual cell count and planimetry. Patients and methods Overall, 40 corneal grafts (20 deep anterior lamellar keratoplasties (DALKs) and 20 penetrating keratoplasties (PKs)) were assessed by scanning-slit IVCM. The endothelial cell density (ECD) was estimated with the automated and the manual cell count method of the instrument's Nidek Advanced Vision Information System (NAVIS) software. The results were compared with planimetry as the reference method, and the agreement was assessed. Results The mean ( ± SD) automated ECD was 2278 ± 524 cells/mm 2 (range 1167-3192 cells/mm 2 ), whereas the manual cell count method gave significantly lower ECDs with a mean of 1213±677 cells/mm 2 (range 218-2440 cells/mm 2 ; Po0.001). The manual cell counts were also significantly lower than those by planimetry, with a mean ECD of 1617 ± 813 cells/mm 2 (range 336-2941, Po0.001). Bland-Altman analyses indicated that the limits of agreement (LoA) between the automated and the planimetry method were À671 and þ 1992 cells/mm 2 , whereas they were À1000 and þ 202 cells/mm 2 when comparing the manual cell counts with planimetry. Conclusion Following keratoplasty, the NAVIS automated method is likely to overestimate endothelial cell counts due to oversegmenting of the cell domains. Automated ECDs are substantially higher than those by the manual counting method or planimetry. The differences are considerably larger post-keratoplasty than for normal corneas, and the methods should not be used interchangeably.

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Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty

Cited by 226 publications

References 14 publications

Assessment of endothelial cell density and corneal thickness in corneal grafts an average of 5 years after penetrating keratoplasty

Assessment of endothelial cell density and corneal thickness in corneal grafts an average of 5 years after penetrating keratoplasty

Donor Age and Corneal Endothelial Cell Loss 5 Years after Successful Corneal Transplantation

In vivo confocal microscopy of the corneal endothelium: comparison of three morphometry methods after corneal transplantation

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