Endothelial morphometric measures to predict endothelial graft failure after penetrating keratoplasty

JAMA Ophthalmol. 2013 May;131(5):601-608. doi: 10.1001/jamaophthalmol.2013.1693.

Abstract

Importance: Endothelial morphometric measures have potential value in predicting graft failure after penetrating keratoplasty.

Objective: To determine whether preoperative and/or postoperative central morphometric measures (endothelial cell density [ECD], coefficient of variation [CV], and percentage of hexagonality [HEX]) and their postoperative changes are predictive of graft failure caused by endothelial decompensation after penetrating keratoplasty to treat a moderate-risk condition, principally Fuchs dystrophy or pseudophakic corneal edema.

Design: In a subset of Cornea Donor Study participants with graft failure, a central reading center determined preoperative and postoperative ECD, CV, and HEX from available central endothelial specular images.

Setting: Cornea Image Analysis Reading Center of the Specular Microscopy Ancillary Study.

Participants: Eighteen patients with graft failure due to endothelial decompensation and 54 individuals matched for most donor and recipient measures at baseline whose grafts did not fail.

Main outcome measure: Change in ECD, CV, and HEX values.

Results: Preoperative ECD was not associated with graft failure (P = .43); however, a lower ECD at 6 months was predictive of subsequent failure (P = .004). Coefficient of variation at 6 months was not associated with graft failure in univariate (P = .91) or multivariate (P = .79) analyses. We found a suggestive trend of higher graft failure with lower HEX values at 6 months (P = .02) but not at the established statistical significance (P < .01). The most recent CV or HEX values, as time-dependent variables, were not associated with graft failure (P = .26 and P = .81, respectively). Endothelial cell density values decreased during follow-up, whereas CV and HEX appear to fluctuate without an apparent trend.

Conclusions and relevance: Endothelial cell density at 6 months after penetrating keratoplasty is predictive of graft failure, whereas CV and HEX appear to fluctuate postoperatively, possibly indicating an unstable endothelial population in clear and failing grafts.

Trial registration: clinicaltrials.gov Identifier: NCT00006411.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cell Count
  • Cell Shape
  • Cell Size
  • Corneal Edema / surgery
  • Corneal Endothelial Cell Loss / diagnosis*
  • Endothelium, Corneal / pathology*
  • Female
  • Fuchs' Endothelial Dystrophy / surgery
  • Graft Rejection / diagnosis*
  • Humans
  • Keratoplasty, Penetrating*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Tissue Donors

Associated data

  • ClinicalTrials.gov/NCT00006411