Impact of Pre- and Intraoperative Factors on Endothelial Cell Density in the Early and Late Stage after Penetrating Keratoplasty

Abstract

Aim This retrospective investigated the impact of donor age, recipient age, donor endothelial cell density, vis-à-tergo, and additional intraoperative lens exchange (triple-procedure) on overall early and late phase postoperative endothelial cell density (ECD) following penetrating keratoplasty (PKP) in various diagnosis groups. Patients and Methods In 590 cases with diagnosed keratoconus (KC), Fuchs dystrophy (FD) and herpes simplex virus infection (HSV) who underwent PKP or triple surgery, the ECD in cells/mm2 was analysed, both preoperatively, with all-sutures-in (early postoperative stage), and after last suture removal. The factors were tested by Mann-Whitney U-test, correlation analysis and linear regression analysis. Outcome Correlation analysis demonstrated a weak negative correlation between the patientʼs ECD and donor age (early postoperative stage: r = − 0.25, p < 0.001; after last suture removal: r = − 0.16; p = 0.003). Regression analysis revealed that donor age did not impact postoperative patient ECD. There was a weak negative correlation between postoperative ECD and recipient age (early postoperative stage: r = − 0.31, p < 0.001; after last suture removal: r = − 0.34, p < 0.001). Regression analysis confirmed the negative impact of recipient age on patient ECD (early postoperative stage: β = − 13.2, p = 0.001; after last suture removal: β = − 4.6, p < 0.001). Correlation analysis determined a weak positive correlation between postoperative ECD and donor endothelial cell density (early postoperative stage: r = 0.37, p < 0.001; after last suture removal: r = 0.32, p < 0.001). Regression analysis also determined that donor endothelial cell density had a positive impact on postoperative ECD following last suture removal (β = 0.4, p < 0.001). Vis-à-tergo and additional lens exchange (triple procedure) had no significant effect on postoperative ECD (p > 0.05). This was also confirmed by the results of the regression analysis after last suture removal. Conclusion Recipient age and donor endothelial cell density have a significant impact on postoperative ECD following PKP. Not all of the statistical tests proved donor age to be a significant influencing factor. Vis-à-tergo and additional lens exchange (triple procedure) had no significant effect on postoperative ECD following PKP.

Unterschiedlicher Verlauf von Immunreaktionen und Endothelzellverlust nach perforierender Low-Risk-Keratoplastik und Descemet Membrane Endothelial Keratoplasty bei Fuchs-Endotheldystrophie

“…Interestingly, endothelial CD in PKP was, on average, 169.5 ± 32.2 cells/mm 2 higher than in DMEK between the period 6 weeks postoperatively and 1 to 2 years postoperatively (p < 0.001), while the donor endothelial CD of the DMEK group was still higher than that of the PKP group. However, Brand et al (2021) demonstrated in their study that high donor endothelial CD has a positive effect on postoperative endothelial CD (p < 0.001) 16 . Even after 5 years, the CD in the present study was still significantly greater with PKP than with DMEK (p = 0.005).…”

“…Interessanterweise war die Endothelzelldichte bei der PKP zwischen dem Zeitraum 6 Wochen postoperativ und 1 – 2 Jahre postoperativ durchschnittlich um 169,5 ± 32,2 Zellen/mm 2 höher als bei der DMEK (p < 0,001), während die Spenderendothelzelldichte der DMEK-Gruppe noch über derjenigen der PKP-Gruppe lag. Brand et al (2021) wiesen in ihrer Studie jedoch nach, dass eine hohe Spenderendothelzelldichte einen positiven Einfluss auf die postoperative Endothelzelldichte hat (p < 0,001) 16 . Auch nach 5 Jahren war die Zelldichte in der vorliegenden Studie bei der PKP immer noch signifikant größer als bei der DMEK (p = 0,005).…”

“…Brand et al (2021) wiesen in ihrer Studie jedoch nach, dass eine hohe Spenderendothelzelldichte einen positiven Einfluss auf die postoperative Endothelzelldichte hat (p < 0,001)[16]. Auch nach5 Jahren war die Zelldichte in der vorliegenden Studie bei der PKP immer noch signifikant größer als bei der DMEK (p = 0,005).…”