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Study: Preop endothelial cell density, donor tissue influence long-term density post-PK
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In a study to assess the effect of perioperative factors on endothelial cell loss after penetrating keratoplasty, researchers found that substantial cell loss occurs despite the age of the donor.
Lass and colleagues also noted in Ophthalmology that a greater endothelial cell density (ECD) before surgery as well as larger donor tissue size was associated with a higher ECD after 10 years.
The researchers followed 176 patients from the Cornea Donor Study who received corneas for a predetermined moderate risk condition, primarily Fuch’s dystrophy or pseudophakic/aphakic corneal edema, and had not experienced graft failure. The corneas were from donors 12 to 75 years old and were assigned at random. Researchers determined ECD after analyzing images of the central endothelium both preoperatively and at several intervals for 10 years postoperatively, according to the study.
Results showed that 125 patients who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76% at 10 years, which translated to a median ECD of 628 cells/mm2. The 51 patients who received a cornea from a donor 66 to 75 years old experienced a median cell loss of 79%, in comparison, which translated to a median ECD of 550 cells/mm2. Researchers also noted that higher ECD values were recorded in cases where patients had a greater preoperative ECD or received larger donor tissue.
"The extension of the Specular Microscopy Ancillary Study (SMAS) to 10 years has shown continued loss of endothelial cells albeit at a slower rate than observed in the first 5 years," the authors concluded. "The study also has demonstrated that in some cases grafts can remain clear after 10 years even at cell densities of <500 cells/mm2. The SMAS has shown that donor age does influence ECD long term, although this finding was primarily influenced by a small group of the youngest donors (12 to <34 years of age) that had the least cell loss and the best graft survival. Nevertheless, as with our graft survival findings, the great majority of clear grafts had similar cell loss over 10 years, which should be reassuring to our patients still undergoing PK for endothelial diseases."
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Ophthalmology. 2013;doi: 10.1016/j.ophtha.2013.08.044.
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