Endothelial Survival After Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Graft Adherence Status
IMPORTANCE: This study evaluates the longevity of Descemet membrane endothelial keratoplasty (DMEK) grafts in terms of endothelial survival and endothelial failure. OBJECTIVE: To determine endothelial survival and its association with the indication for surgery and/or partial graft detachment in DME...
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| Veröffentlicht in: | JAMA ophthalmology 2015-11, Vol.133 (11), p.1277-1285 |
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| creator | Baydoun, Lamis Ham, Lisanne Borderie, Vincent Dapena, Isabel Hou, Jingzhen Frank, Laurence E Oellerich, Silke Melles, Gerrit R. J |
| description | IMPORTANCE: This study evaluates the longevity of Descemet membrane endothelial keratoplasty (DMEK) grafts in terms of endothelial survival and endothelial failure. OBJECTIVE: To determine endothelial survival and its association with the indication for surgery and/or partial graft detachment in DMEK. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study of data collected from August 8, 2006, until June 17, 2015, at a tertiary referral center. A total of 352 eyes were evaluated up to 8 years after DMEK for Fuchs endothelial corneal dystrophy (FECD; n = 314), bullous keratopathy (BK; n = 31), and failed previous endothelial graft (n = 7), of which 314 eyes had complete graft attachment and 38 eyes had partial graft detachment (one-third of the graft surface area or less). Endothelial cell density was measured with specular microscopy, and Kaplan-Meier survival estimates were based on eyes with endothelial failure. Endothelial survival was followed up to 8 years after DMEK. MAIN OUTCOMES AND MEASURES: Endothelial cell density, endothelial failure, and endothelial survival. RESULTS: Endothelial cell density decreased to a mean (SD) of 952 (366) and 771 (321) cells/mm2 at 7 and 8 years postoperatively, respectively. Higher endothelial cell densities were found in eyes with FECD compared with those with BK (estimated mean difference, 261 cells/mm2; 95% CI, 118-404; P = .003) and in eyes with attached grafts compared with those with partially detached grafts (estimated mean difference, 330 cells/mm2; 95% CI, 208-452; P |
| doi_str_mv | 10.1001/jamaophthalmol.2015.3064 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1832247652</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><ama_id>2436657</ama_id><sourcerecordid>1733195568</sourcerecordid><originalsourceid>FETCH-LOGICAL-a312t-3c5234c77cc2025c297c27959ad2312dbc93039024048dc695938fc011592a83</originalsourceid><addsrcrecordid>eNqFkT1PwzAQhi0Eoqj0DzAgjywp_oidhK0qpVQUMbR75DoOSZXEwXYqdeKv46ilwMQtd9I9996dXgAgRmOMEL7filrotnCFqGpdjQnCbEwRD8_AFcE8DjiO6Pmp5mwARtZukY8YoZCySzAgnDJGaHwFPmdNpl2hqlJUcNWZXbnzxSR3ysBHZaWqlYOvqt4Y0Sj4G35RRjjdVsK6_QOc5bmSDuq8F3kvpQcWTeazK3UDRZPBuRG5g5OsUEY1UsGVE66z1-AiF5VVo2MegvXTbD19DpZv88V0sgwExcQFVPpzQxlFUhJEmCRJJEmUsERkxAPZRiYU0QSREIVxJrnv0DiXCGOWEBHTIbg7yLZGf3TKurQu_XNV5b_SnU1xTAkJI-63_ItGlOKEMd6rxgdUGm2tUXnamrIWZp9ilPZepX-9Snuv0t4rP3p73NJtapWdBr-d8cDNAfAKP92Qcs4i-gU3g5xv</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1733195568</pqid></control><display><type>article</type><title>Endothelial Survival After Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Graft Adherence Status</title><source>MEDLINE</source><source>American Medical Association Journals</source><creator>Baydoun, Lamis ; Ham, Lisanne ; Borderie, Vincent ; Dapena, Isabel ; Hou, Jingzhen ; Frank, Laurence E ; Oellerich, Silke ; Melles, Gerrit R. J</creator><creatorcontrib>Baydoun, Lamis ; Ham, Lisanne ; Borderie, Vincent ; Dapena, Isabel ; Hou, Jingzhen ; Frank, Laurence E ; Oellerich, Silke ; Melles, Gerrit R. J</creatorcontrib><description>IMPORTANCE: This study evaluates the longevity of Descemet membrane endothelial keratoplasty (DMEK) grafts in terms of endothelial survival and endothelial failure. OBJECTIVE: To determine endothelial survival and its association with the indication for surgery and/or partial graft detachment in DMEK. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study of data collected from August 8, 2006, until June 17, 2015, at a tertiary referral center. A total of 352 eyes were evaluated up to 8 years after DMEK for Fuchs endothelial corneal dystrophy (FECD; n = 314), bullous keratopathy (BK; n = 31), and failed previous endothelial graft (n = 7), of which 314 eyes had complete graft attachment and 38 eyes had partial graft detachment (one-third of the graft surface area or less). Endothelial cell density was measured with specular microscopy, and Kaplan-Meier survival estimates were based on eyes with endothelial failure. Endothelial survival was followed up to 8 years after DMEK. MAIN OUTCOMES AND MEASURES: Endothelial cell density, endothelial failure, and endothelial survival. RESULTS: Endothelial cell density decreased to a mean (SD) of 952 (366) and 771 (321) cells/mm2 at 7 and 8 years postoperatively, respectively. Higher endothelial cell densities were found in eyes with FECD compared with those with BK (estimated mean difference, 261 cells/mm2; 95% CI, 118-404; P = .003) and in eyes with attached grafts compared with those with partially detached grafts (estimated mean difference, 330 cells/mm2; 95% CI, 208-452; P < .001), until 8 years. In 11 eyes (3.1%) that had concomitant ocular pathology, endothelial failure occurred within 4 years after DMEK. The overall graft survival probability was 0.96 at 5 and 8 years (95% CI, 0.94-0.99). At 8 years, better survival rates were found in eyes with FECD than in those with BK (survival probability, 0.97 [95% CI, 0.95-0.99] vs 0.84 [95% CI, 0.70-0.99], respectively); until the same follow-up, survival probabilities in eyes with attached and partially detached grafts were 0.97 (95% CI, 0.95-0.99) and 0.91 (95% CI, 0.82-0.99), respectively. CONCLUSIONS AND RELEVANCE: Endothelial decay was higher in eyes with a partial graft detachment than in those with attached grafts and lower in eyes with FECD than in those with BK. Endothelial failure only occurred in eyes with concomitant ocular pathology. These results suggest that eyes with DMEK that have undergone surgery for FECD with a completely attached graft may have an excellent prognosis.</description><identifier>ISSN: 2168-6165</identifier><identifier>EISSN: 2168-6173</identifier><identifier>DOI: 10.1001/jamaophthalmol.2015.3064</identifier><identifier>PMID: 26355238</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Cell Adhesion ; Cell Count ; Cell Survival ; Corneal Endothelial Cell Loss - pathology ; Cross-Sectional Studies ; Descemet Stripping Endothelial Keratoplasty ; Endothelium, Corneal - pathology ; Female ; Fuchs' Endothelial Dystrophy - physiopathology ; Fuchs' Endothelial Dystrophy - surgery ; Graft Rejection - pathology ; Graft Survival ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Tissue Adhesions ; Tissue Donors ; Transplant Recipients ; Young Adult</subject><ispartof>JAMA ophthalmology, 2015-11, Vol.133 (11), p.1277-1285</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamaophthalmology/articlepdf/10.1001/jamaophthalmol.2015.3064$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2015.3064$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76231,76234</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26355238$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Baydoun, Lamis</creatorcontrib><creatorcontrib>Ham, Lisanne</creatorcontrib><creatorcontrib>Borderie, Vincent</creatorcontrib><creatorcontrib>Dapena, Isabel</creatorcontrib><creatorcontrib>Hou, Jingzhen</creatorcontrib><creatorcontrib>Frank, Laurence E</creatorcontrib><creatorcontrib>Oellerich, Silke</creatorcontrib><creatorcontrib>Melles, Gerrit R. J</creatorcontrib><title>Endothelial Survival After Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Graft Adherence Status</title><title>JAMA ophthalmology</title><addtitle>JAMA Ophthalmol</addtitle><description>IMPORTANCE: This study evaluates the longevity of Descemet membrane endothelial keratoplasty (DMEK) grafts in terms of endothelial survival and endothelial failure. OBJECTIVE: To determine endothelial survival and its association with the indication for surgery and/or partial graft detachment in DMEK. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study of data collected from August 8, 2006, until June 17, 2015, at a tertiary referral center. A total of 352 eyes were evaluated up to 8 years after DMEK for Fuchs endothelial corneal dystrophy (FECD; n = 314), bullous keratopathy (BK; n = 31), and failed previous endothelial graft (n = 7), of which 314 eyes had complete graft attachment and 38 eyes had partial graft detachment (one-third of the graft surface area or less). Endothelial cell density was measured with specular microscopy, and Kaplan-Meier survival estimates were based on eyes with endothelial failure. Endothelial survival was followed up to 8 years after DMEK. MAIN OUTCOMES AND MEASURES: Endothelial cell density, endothelial failure, and endothelial survival. RESULTS: Endothelial cell density decreased to a mean (SD) of 952 (366) and 771 (321) cells/mm2 at 7 and 8 years postoperatively, respectively. Higher endothelial cell densities were found in eyes with FECD compared with those with BK (estimated mean difference, 261 cells/mm2; 95% CI, 118-404; P = .003) and in eyes with attached grafts compared with those with partially detached grafts (estimated mean difference, 330 cells/mm2; 95% CI, 208-452; P < .001), until 8 years. In 11 eyes (3.1%) that had concomitant ocular pathology, endothelial failure occurred within 4 years after DMEK. The overall graft survival probability was 0.96 at 5 and 8 years (95% CI, 0.94-0.99). At 8 years, better survival rates were found in eyes with FECD than in those with BK (survival probability, 0.97 [95% CI, 0.95-0.99] vs 0.84 [95% CI, 0.70-0.99], respectively); until the same follow-up, survival probabilities in eyes with attached and partially detached grafts were 0.97 (95% CI, 0.95-0.99) and 0.91 (95% CI, 0.82-0.99), respectively. CONCLUSIONS AND RELEVANCE: Endothelial decay was higher in eyes with a partial graft detachment than in those with attached grafts and lower in eyes with FECD than in those with BK. Endothelial failure only occurred in eyes with concomitant ocular pathology. These results suggest that eyes with DMEK that have undergone surgery for FECD with a completely attached graft may have an excellent prognosis.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cell Adhesion</subject><subject>Cell Count</subject><subject>Cell Survival</subject><subject>Corneal Endothelial Cell Loss - pathology</subject><subject>Cross-Sectional Studies</subject><subject>Descemet Stripping Endothelial Keratoplasty</subject><subject>Endothelium, Corneal - pathology</subject><subject>Female</subject><subject>Fuchs' Endothelial Dystrophy - physiopathology</subject><subject>Fuchs' Endothelial Dystrophy - surgery</subject><subject>Graft Rejection - pathology</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Postoperative Complications</subject><subject>Retrospective Studies</subject><subject>Tissue Adhesions</subject><subject>Tissue Donors</subject><subject>Transplant Recipients</subject><subject>Young Adult</subject><issn>2168-6165</issn><issn>2168-6173</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkT1PwzAQhi0Eoqj0DzAgjywp_oidhK0qpVQUMbR75DoOSZXEwXYqdeKv46ilwMQtd9I9996dXgAgRmOMEL7filrotnCFqGpdjQnCbEwRD8_AFcE8DjiO6Pmp5mwARtZukY8YoZCySzAgnDJGaHwFPmdNpl2hqlJUcNWZXbnzxSR3ysBHZaWqlYOvqt4Y0Sj4G35RRjjdVsK6_QOc5bmSDuq8F3kvpQcWTeazK3UDRZPBuRG5g5OsUEY1UsGVE66z1-AiF5VVo2MegvXTbD19DpZv88V0sgwExcQFVPpzQxlFUhJEmCRJJEmUsERkxAPZRiYU0QSREIVxJrnv0DiXCGOWEBHTIbg7yLZGf3TKurQu_XNV5b_SnU1xTAkJI-63_ItGlOKEMd6rxgdUGm2tUXnamrIWZp9ilPZepX-9Snuv0t4rP3p73NJtapWdBr-d8cDNAfAKP92Qcs4i-gU3g5xv</recordid><startdate>20151101</startdate><enddate>20151101</enddate><creator>Baydoun, Lamis</creator><creator>Ham, Lisanne</creator><creator>Borderie, Vincent</creator><creator>Dapena, Isabel</creator><creator>Hou, Jingzhen</creator><creator>Frank, Laurence E</creator><creator>Oellerich, Silke</creator><creator>Melles, Gerrit R. J</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>20151101</creationdate><title>Endothelial Survival After Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Graft Adherence Status</title><author>Baydoun, Lamis ; Ham, Lisanne ; Borderie, Vincent ; Dapena, Isabel ; Hou, Jingzhen ; Frank, Laurence E ; Oellerich, Silke ; Melles, Gerrit R. J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a312t-3c5234c77cc2025c297c27959ad2312dbc93039024048dc695938fc011592a83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cell Adhesion</topic><topic>Cell Count</topic><topic>Cell Survival</topic><topic>Corneal Endothelial Cell Loss - pathology</topic><topic>Cross-Sectional Studies</topic><topic>Descemet Stripping Endothelial Keratoplasty</topic><topic>Endothelium, Corneal - pathology</topic><topic>Female</topic><topic>Fuchs' Endothelial Dystrophy - physiopathology</topic><topic>Fuchs' Endothelial Dystrophy - surgery</topic><topic>Graft Rejection - pathology</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Postoperative Complications</topic><topic>Retrospective Studies</topic><topic>Tissue Adhesions</topic><topic>Tissue Donors</topic><topic>Transplant Recipients</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Baydoun, Lamis</creatorcontrib><creatorcontrib>Ham, Lisanne</creatorcontrib><creatorcontrib>Borderie, Vincent</creatorcontrib><creatorcontrib>Dapena, Isabel</creatorcontrib><creatorcontrib>Hou, Jingzhen</creatorcontrib><creatorcontrib>Frank, Laurence E</creatorcontrib><creatorcontrib>Oellerich, Silke</creatorcontrib><creatorcontrib>Melles, Gerrit R. J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>JAMA ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Baydoun, Lamis</au><au>Ham, Lisanne</au><au>Borderie, Vincent</au><au>Dapena, Isabel</au><au>Hou, Jingzhen</au><au>Frank, Laurence E</au><au>Oellerich, Silke</au><au>Melles, Gerrit R. J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endothelial Survival After Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Graft Adherence Status</atitle><jtitle>JAMA ophthalmology</jtitle><addtitle>JAMA Ophthalmol</addtitle><date>2015-11-01</date><risdate>2015</risdate><volume>133</volume><issue>11</issue><spage>1277</spage><epage>1285</epage><pages>1277-1285</pages><issn>2168-6165</issn><eissn>2168-6173</eissn><abstract>IMPORTANCE: This study evaluates the longevity of Descemet membrane endothelial keratoplasty (DMEK) grafts in terms of endothelial survival and endothelial failure. OBJECTIVE: To determine endothelial survival and its association with the indication for surgery and/or partial graft detachment in DMEK. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cross-sectional study of data collected from August 8, 2006, until June 17, 2015, at a tertiary referral center. A total of 352 eyes were evaluated up to 8 years after DMEK for Fuchs endothelial corneal dystrophy (FECD; n = 314), bullous keratopathy (BK; n = 31), and failed previous endothelial graft (n = 7), of which 314 eyes had complete graft attachment and 38 eyes had partial graft detachment (one-third of the graft surface area or less). Endothelial cell density was measured with specular microscopy, and Kaplan-Meier survival estimates were based on eyes with endothelial failure. Endothelial survival was followed up to 8 years after DMEK. MAIN OUTCOMES AND MEASURES: Endothelial cell density, endothelial failure, and endothelial survival. RESULTS: Endothelial cell density decreased to a mean (SD) of 952 (366) and 771 (321) cells/mm2 at 7 and 8 years postoperatively, respectively. Higher endothelial cell densities were found in eyes with FECD compared with those with BK (estimated mean difference, 261 cells/mm2; 95% CI, 118-404; P = .003) and in eyes with attached grafts compared with those with partially detached grafts (estimated mean difference, 330 cells/mm2; 95% CI, 208-452; P < .001), until 8 years. In 11 eyes (3.1%) that had concomitant ocular pathology, endothelial failure occurred within 4 years after DMEK. The overall graft survival probability was 0.96 at 5 and 8 years (95% CI, 0.94-0.99). At 8 years, better survival rates were found in eyes with FECD than in those with BK (survival probability, 0.97 [95% CI, 0.95-0.99] vs 0.84 [95% CI, 0.70-0.99], respectively); until the same follow-up, survival probabilities in eyes with attached and partially detached grafts were 0.97 (95% CI, 0.95-0.99) and 0.91 (95% CI, 0.82-0.99), respectively. CONCLUSIONS AND RELEVANCE: Endothelial decay was higher in eyes with a partial graft detachment than in those with attached grafts and lower in eyes with FECD than in those with BK. Endothelial failure only occurred in eyes with concomitant ocular pathology. These results suggest that eyes with DMEK that have undergone surgery for FECD with a completely attached graft may have an excellent prognosis.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>26355238</pmid><doi>10.1001/jamaophthalmol.2015.3064</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Cell Adhesion Cell Count Cell Survival Corneal Endothelial Cell Loss - pathology Cross-Sectional Studies Descemet Stripping Endothelial Keratoplasty Endothelium, Corneal - pathology Female Fuchs' Endothelial Dystrophy - physiopathology Fuchs' Endothelial Dystrophy - surgery Graft Rejection - pathology Graft Survival Humans Male Middle Aged Postoperative Complications Retrospective Studies Tissue Adhesions Tissue Donors Transplant Recipients Young Adult |
| title | Endothelial Survival After Descemet Membrane Endothelial Keratoplasty: Effect of Surgical Indication and Graft Adherence Status |
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