Endothelial Cell Loss in Penetrating Keratoplasty

Culbertson, William W.; Abbott, Richard L.; Forster, Richard K.

doi:10.1016/s0161-6420(82)34754-5

Cited by 79 publications

(37 citation statements)

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“…In the first 2 post-operative years after PKP, an overall endothelial cell loss of 33 % has been reported [43], similarly to our data of 15.8 % per year in that period. After these 2 initial years, ECD continues to decrease with a three to seven times higher rate than normally for up to 20 years after surgery [7,8,35,36,42].…”

Section: Financial Interestsupporting

confidence: 92%

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: 92%

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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“…There were no signifi¬ cant differences between these corne¬ as and corneas with death to enucle¬ ation times of less than three hours although the sample size was small. COMMENT Our results show that the quality of the specular microscopic view of the donor endothelium decreases consid¬ erably when moist chamber storage is prolonged beyond 12 hours. This appears to be due mainly to the increase in the number of Descemet's folds that develop as the corneas swell.…”

Section: Methodsmentioning

confidence: 70%

Specular Microscopic Evaluation of Donor Corneal Endothelium

Matsuda

Yee

Glasser

et al. 1986

Archives of Ophthalmology

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“…Some studies suggest that there is no difference in endothelial cell loss comparing older and younger donor tissue, [2][3][4][5] whereas other studies suggest that there is a relationship between endothelial cell loss and donor age. 6 -8 The Cornea Donor Study (CDS) has evaluated the effect of donor age on 5-year graft survival in eyes undergoing cornea transplantation for a corneal condition associated with moderate risk of graft failure, principally Fuchs' dystrophy and pseudophakic corneal edema.…”

mentioning

confidence: 99%

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

Jh¹,

Rl²,

Dontchev³

et al. 2008

Ophthalmology

167

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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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Endothelial Cell Loss in Penetrating Keratoplasty

Cited by 79 publications

References 15 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

Specular Microscopic Evaluation of Donor Corneal Endothelium

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

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