Endothelial Cell Density to Predict Endothelial Graft Failure After Penetrating Keratoplasty.
Lass, Jonathan H. MD; Sugar, Alan MD; Benetz, Beth Ann MA; Beck, Roy W. MD, PhD; Dontchev, Mariya MPH; Gal, Robin L. MSPH; Kollman, Craig PhD; Gross, Robert MD; Heck, Ellen MS, MA; Holland, Edward J. MD; Mannis, Mark J. MD; Raber, Irving MD; Stark, Walter MD; Stulting, R. Doyle MD, PhD; for the Cornea Donor Study Investigator Group
[Article]
Archives of Ophthalmology.
128(1):63-69, January 2010.
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Objective: To determine whether preoperative and/or postoperative central endothelial cell density (ECD) and its rate of decline postoperatively are predictive of graft failure caused by endothelial decompensation following penetrating keratoplasty to treat a moderate-risk condition, principally, Fuchs dystrophy or pseudophakic corneal edema.
Methods: In a subset of Cornea Donor Study participants, a central reading center determined preoperative and postoperative ECD from available specular images for 17 grafts that failed because of endothelial decompensation and 483 grafts that did not fail.
Results: Preoperative ECD was not predictive of graft failure caused by endothelial decompensation (P = .91). However, the 6-month ECD was predictive of subsequent failure (P < .001). Among those that had not failed within the first 6 months, the 5-year cumulative incidence ( /-95% confidence interval) of failure was 13% ( /-12%) for the 33 participants with a 6-month ECD of less than 1700 cells/mm2 vs 2% ( /-3%) for the 137 participants with a 6-month ECD of 2500 cells/mm2 or higher. After 5 years' follow-up, 40 of 277 participants (14%) with a clear graft had an ECD below 500 cells/mm2.
Conclusions: Preoperative ECD is unrelated to graft failure from endothelial decompensation, whereas there is a strong correlation of ECD at 6 months with graft failure from endothelial decompensation. A graft can remain clear after 5 years even when the ECD is below 500 cells/mm2.
Clinical Trial Registry: clinicaltrials.gov Identifier: NCT00006411
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