Donor age and factors related to endothelial cell loss 10 years after penetrating keratoplasty: Specular Microscopy Ancillary Study

To examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty (PKP). Multicenter, prospective, double-masked clinical trial. We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥...

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Veröffentlicht in:Ophthalmology (Rochester, Minn.) Minn.), 2013-12, Vol.120 (12), p.2428-2435
Hauptverfasser: Lass, Jonathan H, Benetz, Beth Ann, Gal, Robin L, Kollman, Craig, Raghinaru, Dan, Dontchev, Mariya, Mannis, Mark J, Holland, Edward J, Chow, Christopher, McCoy, Kristen, Price, Jr, Francis W, Sugar, Alan, Verdier, David D, Beck, Roy W
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container_end_page 2435
container_issue 12
container_start_page 2428
container_title Ophthalmology (Rochester, Minn.)
container_volume 120
creator Lass, Jonathan H
Benetz, Beth Ann
Gal, Robin L
Kollman, Craig
Raghinaru, Dan
Dontchev, Mariya
Mannis, Mark J
Holland, Edward J
Chow, Christopher
McCoy, Kristen
Price, Jr, Francis W
Sugar, Alan
Verdier, David D
Beck, Roy W
description To examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty (PKP). Multicenter, prospective, double-masked clinical trial. We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥ 10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). Corneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD). Endothelial cell density at 10 years. Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm(2) (interquartile range [IQR], 522-850 cells/mm(2)), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm(2) (IQR, 483-694 cells/mm(2); P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P
doi_str_mv 10.1016/j.ophtha.2013.08.044
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Multicenter, prospective, double-masked clinical trial. We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥ 10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). Corneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD). Endothelial cell density at 10 years. Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm(2) (interquartile range [IQR], 522-850 cells/mm(2)), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm(2) (IQR, 483-694 cells/mm(2); P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P&lt;0.001) and larger donor tissue size (P&lt;0.001). Forty-two of the 176 participants (24%) had an ECD of &lt;500 cells/mm(2) at 10 years and only 24 (14%) had an ECD of &gt;1000 cells/mm(2). Substantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. 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Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm(2) (interquartile range [IQR], 522-850 cells/mm(2)), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm(2) (IQR, 483-694 cells/mm(2); P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P&lt;0.001) and larger donor tissue size (P&lt;0.001). Forty-two of the 176 participants (24%) had an ECD of &lt;500 cells/mm(2) at 10 years and only 24 (14%) had an ECD of &gt;1000 cells/mm(2). Substantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. 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Multicenter, prospective, double-masked clinical trial. We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥ 10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). Corneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD). Endothelial cell density at 10 years. Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm(2) (interquartile range [IQR], 522-850 cells/mm(2)), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm(2) (IQR, 483-694 cells/mm(2); P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P&lt;0.001) and larger donor tissue size (P&lt;0.001). Forty-two of the 176 participants (24%) had an ECD of &lt;500 cells/mm(2) at 10 years and only 24 (14%) had an ECD of &gt;1000 cells/mm(2). Substantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. Greater preoperative ECD and larger donor tissue size are associated with higher ECD at 10 years.</abstract><cop>United States</cop><pmid>24246826</pmid><doi>10.1016/j.ophtha.2013.08.044</doi><tpages>8</tpages></addata></record>
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source MEDLINE; Elsevier ScienceDirect Journals
subjects Adolescent
Adult
Aged
Aging - pathology
Cell Count
Child
Corneal Edema - physiopathology
Corneal Edema - surgery
Corneal Endothelial Cell Loss - diagnosis
Corneal Endothelial Cell Loss - etiology
Corneal Endothelial Cell Loss - physiopathology
Double-Blind Method
Endothelium, Corneal - pathology
Eye Banks
Female
Fuchs' Endothelial Dystrophy - physiopathology
Fuchs' Endothelial Dystrophy - surgery
Graft Survival - physiology
Humans
Keratoplasty, Penetrating
Male
Middle Aged
Postoperative Complications
Prospective Studies
Risk Factors
Time Factors
Tissue Donors
Young Adult
title Donor age and factors related to endothelial cell loss 10 years after penetrating keratoplasty: Specular Microscopy Ancillary Study
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