Endothelial Morphometric Measures to Predict Endothelial Graft Failure After Penetrating Keratoplasty

Benetz, Beth Ann; Lass, Jonathan H.; Gal, Robin L.; Sugar, Alan; Menegay, Harry; Dontchev, Mariya; Kollman, Craig; Beck, Roy W.; Mannis, Mark J.; Holland, Edward J.; Gorovoy, Mark S.; Hannush, Sadeer B.; Bokosky, John E.; Caudill, James W.

doi:10.1001/jamaophthalmol.2013.1693

Cited by 34 publications

(16 citation statements)

References 32 publications

(34 reference statements)

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“…Specular microscopy and Scheimpflug imaging are established methods to monitor postkeratoplasty corneas by assessing a decrease in endothelial cell density (on specular microscopy) and an increase in corneal thickness (with Scheimpflug imaging). This combination of changes may be expected to occur in secondary graft failure not associated with allograft rejection (Lass et al 2010;Benetz et al 2013;Baydoun et al 2015). However, if associated with an upcoming rejection episode, our study showed that these two criteria are virtually always seen in combination with changes in endothelial cell morphology and/or the presence of subclinical keratic precipitates.…”

Section: Discussionmentioning

confidence: 56%

Combined specular microscopy and Scheimpflug imaging to improve detection of an upcoming allograft rejection after DMEK

Baydoun

Bruinsma

Santander-García

et al. 2019

Acta Ophthalmologica

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Purpose: To assess whether combined analysis of specular microscopy and Scheimpflug imaging improves detection of an upcoming allograft rejection following Descemet membrane endothelial keratoplasty (DMEK). Methods: Retrospective analysis of 22 eyes that had developed a clinical proven allograft rejection 28 (AE22) months (range: 4-84 months) after DMEK. Specular microscopy and Scheimpflug images routinely made after DMEK were retrospectively analysed for changes in endothelial cell morphology (e.g. nuclear activation), cell density (>10%) and pachymetry (>7%), and/or the presence of subclinical keratic precipitates. The same parameters were evaluated for 22 control eyes matched for age, gender and surgery indication. Results: A total of 20/22 eyes (91%) showed detectable changes 0.25-75 months before allograft rejection became clinically manifest: 13/22 (59%) showed both specular microscopy and Scheimpflug imaging changes; 5/22 (23%) only had changes on Scheimpflug imaging; and 2/22 (9%) only had specular microscopy changes. In 18/22 (82%) and 14/22 (64%) eyes, subclinical keratic precipitates and endothelial cell morphology changes could be detected, respectively. A total of 11/22 (50%) eyes concurrently showed a >10% drop in endothelial cell density and 4/22 (18%) a >7% pachymetry increase. Of the control eyes, 7/22 (32%) showed changes with specular microscopy but not with Scheimpflug imaging. Conclusions: Combined analysis of specular microscopy and Scheimpflug imaging may allow recognizing an upcoming allograft rejection in over 90% of eyes and up to 6 years before rejection becomes clinically manifest. Early recognition of eyes at risk may allow for targeted intensified steroid treatment to prevent endothelial cell damage associated with rejection.

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Section: Discussionmentioning

confidence: 56%

Combined specular microscopy and Scheimpflug imaging to improve detection of an upcoming allograft rejection after DMEK

Baydoun

Bruinsma

Santander-García

et al. 2019

Acta Ophthalmologica

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“…In a longitudinal cohort study of 500 consecutive penetrating keratoplasties, a low endothelial cell density before surgery (p = 0.007) and 2 months postoperatively (p = 0.002) were identified as significant risk factors for developing late endothelial failure [65]. However, a recent study conducted by the Corneal Donor Study Investigator Group revealed that graft failure from endothelial decompensation was not related to donor ECD; nevertheless, they reported that graft failure was strongly correlated with ECD at 6 months after penetrating keratoplasty [66,67]. Among endothelial cell morphology indices, only lower hexagonality at 6 months after penetrating keratoplasty showed a suggestive trend of higher graft failure (p = 0.02) [67].…”

Section: Endothelial Cell Density and Morphological Indicators As Gramentioning

confidence: 99%

“…However, a recent study conducted by the Corneal Donor Study Investigator Group revealed that graft failure from endothelial decompensation was not related to donor ECD; nevertheless, they reported that graft failure was strongly correlated with ECD at 6 months after penetrating keratoplasty [66,67]. Among endothelial cell morphology indices, only lower hexagonality at 6 months after penetrating keratoplasty showed a suggestive trend of higher graft failure (p = 0.02) [67]. Recently, newer surgical techniques for endothelial dysfunction, including Descemet's stripping automated endothelial keratoplasty (DSAEK), Descemet's membrane endothelial keratoplasty (DMEK), and Pre-Descemet's endothelial keratoplasty (PDEK) have been used to replace the standard technique of penetrating keratoplasty [68].…”

Section: Endothelial Cell Density and Morphological Indicators As Gramentioning

confidence: 99%

Variable Responses to Corneal Grafts: Insights from Immunology and Systems Biology

Zazzo

Lee

Sung

et al. 2020

JCM

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Corneal grafts interact with their hosts via complex immunobiological processes that sometimes lead to graft failure. Prediction of graft failure is often a tedious task due to the genetic and nongenetic heterogeneity of patients. As in other areas of medicine, a reliable prediction method would impact therapeutic decision-making in corneal transplantation. Valuable insights into the clinically observed heterogeneity of host responses to corneal grafts have emerged from multidisciplinary approaches, including genomics analyses, mechanical studies, immunobiology, and theoretical modeling. Here, we review the emerging concepts, tools, and new biomarkers that may allow for the prediction of graft survival.

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“…3,12 Beneatz ve ark. 13 greft yetmezliği açısından belirleyici faktörün EHS olduğunu, DK ve hegzagonalite oranlarının saydam ve yetmezlik gelişen greftlerde değişkenlik gösterdiğini ifade etmişlerdir. Speküler mikroskopi çalışmaları endotele ait morfolojik parametrelerin ırk, cinsiyet ve yaş ile değiştiğini göstermiştir.…”

Section: Gereç Ve Yöntemunclassified

Kartal Eğitim ve Araştırma Hastanesi Kornea Bankası Donörlerine Ait Speküler Mikroskopi Verileri

Kartal¹,

Kandemir²,

Akmaz³

et al. 2014

tjo

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Amaç: Göz bankasında speküler mikroskopinin (SM) gerekliliği açısından donör kornea endotel hücre morfolojisinin donörün epidemiyolojik özellikleri ve ölüm zamanı ile ilişkisini değerlendirmek. Gereç ve Yöntem: Dr. Lütfi Kırdar Kartal Eğitim ve Araştırma Hastanesi'ne bağlı Kornea Bankası'nda 2010-2012 tarihleri arasında alınan donör kornealara ait speküler mikroskopi (SM) verileri retrospektif olarak değerlendirildi. Bulgular: Yaş ortalaması 40,11±15,51 yıl olan 606 donörden 1180 adet kornea dokusu alınmıştı ve donörlerin 449'u (%74,1) erkek, 157'si (%25,9) kadındı. Kornea alınma süresi, ölüm saati sonrası ortalama 1,52±0,6 saat idi. Endotel hücre sayısı (EHS) ortalama 2852,07±542,15 hücre/mm 2 olup cinsiyete göre anlamlı bir farklılık yoktu (p>0,05). Yaş gruplarına göre ≤20 yaş donörlerde EHS en yüksekti ve diğer yaş grupları ile arada anlamlı farklılık vardı (p<0,001). Ortalama hücre alanı (OHA) 367,86±86,30 µm 2 ; hegzagonalite oranı (%) 49,29±7,76; değişkenlik katsayısı (DK) 31,52±6,37 olup bu değişkenlerle yaş arasında istatistiksel açıdan anlamlı ilişki mevcuttu (p<0,001). Cinsiyete göre OHA anlamlı farklılık gösterirken (p<0,05); cinsiyet ile hegzagonalite ve DK arasında ilişki saptanmadı (p>0,05). Ölüm saati-kornea alınma saati arasında geçen süreye göre gruplar arasında EHS, OHA, DK ve hegzagonalite değerleri için istatistiksel açıdan anlamlı farklılık izlenmedi (p>0,05). Endotel hücre sayısı <2000 hücre/mm 2 olan donörlerin %79'u ≤60 yaş grubunda yer almaktaydı ve >61 yaş grubundaki donörlerin %78'inde EHS ≥2000 hücre/mm 2 idi. Sonuç: Donör kornea morfolojik parametreleri yaş ile anlamlı ilişki göstermesine rağmen EHS<2000 hücre/mm 2 olan donör dağılımı SM'nin keratoplasti öncesi standart bir işlem olarak kullanılması gerektiğini göstermektedir. (Turk J Ophthalmol 2014; 44: 190-5) Anah tar Ke li me ler: Göz bankaları, keratoplasti, doku vericileri, speküler mikroskopi Objective: To evaluate the correlation between donor cornea endothelial cell morphology, epidemiological features of the donor and time of death in terms of necessity of specular microscopy (SM) in eye bank. Materials and Methods: SM data acquired from Dr. Lütfi Kırdar Kartal Training and Research Hospital Cornea Bank between 2010 and 2012 were retrospectively evaluated. Results: One thousand one hundred eighty cornea tissues were excised from 606 donors. The mean age of the donors was 40.11±15.51 years. Four hundred forty-nine (74.1%) donors were male and 157 (25.9%) donors were female. The mean duration of corneal excision was 1.52±0.6 hours after the time of death. The mean endothelial cell density (ECD) was 2852.07±542.15 cells/mm 2 and there was no significant difference with respect to gender (p>0.05). According to age groups, the endothelial cell density was highest at age 20 years and below, and there was a significant difference compared to the other age groups (p<0.001).The mean cell area (MCA) was 367.86±86.30 µm 2 ; the hexagonality rate was 49.29±7.76 (%); the coefficient of variation (CV) was 31.52±6.37 and there was a stat...

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Endothelial Morphometric Measures to Predict Endothelial Graft Failure After Penetrating Keratoplasty

Cited by 34 publications

References 32 publications

Combined specular microscopy and Scheimpflug imaging to improve detection of an upcoming allograft rejection after DMEK

Combined specular microscopy and Scheimpflug imaging to improve detection of an upcoming allograft rejection after DMEK

Variable Responses to Corneal Grafts: Insights from Immunology and Systems Biology

Kartal Eğitim ve Araştırma Hastanesi Kornea Bankası Donörlerine Ait Speküler Mikroskopi Verileri

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