Factors influencing graft endothelial cell density after descemet stripping automated endothelial keratoplasty

Abstract

Purpose:To determine the factors that influence the endothelial cell density (ECD) of donor grafts after Descemet stripping automated endothelial keratoplasty (DSAEK).Methods:This retrospective, interventional case series comprised 77 eyes of 64 patients who underwent DSAEK. Confocal microscopy was performed at the final follow-up examination to evaluate the endothelial cell count, cell morphology, and graft thickness. Univariate and multiple linear regression analyses were used to investigate recipient-, donor-, surgical-, and postoperative related variables capable of influencing graft endothelial cell counts after DSAEK.Results:The mean patient age was 62.3 ± 15.6 years; patients were followed-up for 26.2 ± 20.9 months postoperatively. Forty-six eyes (59.7%) underwent stand-alone DSAEK; 31 eyes (40.3%) underwent DSAEK combined with cataract surgery. The donor trephination size was 8.0 ± 0.21 mm. The mean donor age was 30.4 ± 11.2 years, and the mean preoperative endothelial cell density was 3127.4 ± 315.1 cells/mm2, which decreased to 1788.6 ± 716.5 cells/mm2 postoperatively (P < 0.001). The mean postoperative central graft thickness was 102.4 ± 31.6 μm. Univariate analysis revealed that postoperative ECD was significantly associated with death to preservation time (P = 0.046), graft thickness (P = 0.016), follow-up duration (P = 0.005), and graft non-attachment (P = 0.049). Multiple regression analyses identified graft thickness (β = 10.62, P = 0.003) and follow-up duration (β = -22.09, P = 0.001) as the significant characteristics influencing postoperative ECD.Conclusion:The primary predictors of ECD after DSAEK were graft thickness and duration of follow-up. Surgeons’ requests for ultrathin DSAEK donor grafts to improve visual outcomes might not have the desired postoperative outcome with respect to ECD.

Influence of time to procurement, incubation and release of organ cultured donor corneas on graft failure after Descemet Stripping Automated Endothelial Keratoplasty

“…Other studies have observed that the gender of the donor and the recipient did not influence the risk of graft failure or ECD reduction in DSAEK patients which supports our findings (Javadi et al. 2018; Madzak & Hjortdal 2018). Still, the influence of sex match/mismatch between donor and recipient needs to be further studied.…”

“…Similarly, Potapenko et al found no difference in graft survival for matching of genders between the donor and recipient with a 2-year survival analysis of 1789 DSAEK patients, but they did observe corneas from male donors to have a worse survival rate independent of recipient gender (Potapenko et al 2017). Other studies have observed that the gender of the donor and the recipient did not influence the risk of graft failure or ECD reduction in DSAEK patients which supports our findings (Javadi et al 2018;Madzak & Hjortdal 2018). Still, the influence of sex match/ mismatch between donor and recipient needs to be further studied.…”

Deep Learning for Assessing the Corneal Endothelium from Specular Microscopy Images up to 1 Year after Ultrathin-DSAEK Surgery

“…Clinically, we obtained an average ECD loss of 46.3% at month 6 and 49.1% at month 12, which was similar (or slightly higher) than other cases found in the literature. For instance, the ECD loss reported after 12 months from UT-DSAEK surgery was 49% by Feng et al, 43 38.9% by Graffi et al, 44 and 35.6% by Busin et al 8 For DSAEK, van Cleynenbreugel et al 45 reported a 40.2% loss after 6 months, Guerra et al 46 a 34.9% loss after 12 months, and Javadi et al 47 a 42.8% at 2 years of follow-up. We observed that our cohort showed a large variability on ECD loss at the different time intervals, without a clear pattern ( Fig.…”

Experimental design of a culture approach for corneal endothelial cells

“…Sketching the limits of cultured CECs expansion is an unavoidable safety issue to be addressed in order to advance onto an in-vivo model. Our study allows guaranteeing cellular and tissular quality, as well as functionality for transplantation so further efforts might focus on improving surgery practices [33] and suggesting further monitoring techniques.…”