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JAMA Ophthalmol. 2013 May;131(5):601-8. doi: 10.1001/jamaophthalmol.2013.1693.

Endothelial morphometric measures to predict endothelial graft failure after penetrating keratoplasty.

Author information

1
Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH, USA.

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.

PMID:
23493999
PMCID:
PMC4179110
DOI:
10.1001/jamaophthalmol.2013.1693
[Indexed for MEDLINE]
Free PMC Article
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