Parameters Associated With Endothelial Cell Density Variability After Descemet Membrane Endothelial Keratoplasty

Identification of the preoperative and perioperative factors that predict postoperative endothelial cell density after Descemet membrane endothelial keratoplasty: A retrospective cohort study

“…Moreover, a study using prospective transplant registry data on 752 DMEK-treated eyes showed with multivariate analysis that surgical difficulty was a risk factor for both rebubbling (Odds Ratio = 2.28, 95% confidence intervals = 1.20–4.33, p = 0.012) and early graft failure (Odds Ratio = 2.93, 95% confidence intervals = 1.42–6.04, p = 0.012) [ 65 ]. These observations are notable because graft detachment (or rebubbling, a surrogate measure of graft detachment) associated repeatedly with ECL in three of the five comprehensive studies that have studied this variable [ 20 , 45 , 46 ] ( S1 Table ). Other studies have also observed this relationship in DMEK [ 38 , 65 – 68 ].…”

“…This notion is supported by several other studies. First, two of the seven comprehensive studies examined the influence of difficult surgery on ECL [ 44 , 45 ]. One, which was on a cohort of 351 eyes, found that intraoperative complications such as unfolding difficulties associated significantly with higher ECL at 48 months (Estimate 6.50, 95% confidence intervals 0.59–12.41, p = 0.032) [ 45 ].…”

“…First, two of the seven comprehensive studies examined the influence of difficult surgery on ECL [ 44 , 45 ]. One, which was on a cohort of 351 eyes, found that intraoperative complications such as unfolding difficulties associated significantly with higher ECL at 48 months (Estimate 6.50, 95% confidence intervals 0.59–12.41, p = 0.032) [ 45 ]. However, the second comprehensive study, which was on 2485 eyes, did not find that intraoperative complications predicted ECL [ 44 ].…”

“…With the aim of further improving DMEK outcomes, several studies have comprehensively sought to identify the preoperative and perioperative factors that associate with low ECD after DMEK ( S1 Table ) [ 20 , 43 – 48 ]. However, there are significant variations between these studies in terms of the predictive factors that have been found: for example, older patient age associates with worse ECL in two comprehensive studies [ 20 , 45 ] but not in five others [ 43 , 44 , 46 – 48 ]. To further clarify this issue, we conducted a retrospective cohort study to determine which of a large range of preoperative and perioperative factors can predict ECD at 6 and 12 postoperative months.…”

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

“…In a recent study evaluating the factors associated with graft survival and ECD after DSAEK, lower graft ECD was identified as a significant predisposing factor for lower postoperative ECD, but was not a predisposing factor for graft failure [70]. For DMEK, lower graft ECD was also found as a significant risk factor for higher postoperative ECD loss by multinominal regression analysis comparing groups of eyes with low and high endothelial cell loss [71]. In a genome-wide association study of specular microscopic findings in 6125 Icelanders, an intergenic variant (rs78658973(A), frequency = 28.3%) close to ANAPC1 (anaphase-promoting complex subunit 1) was strongly associated with decreased ECD [72].…”