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Clinical Sciences
Sep 2011

Baseline Factors Related to Endothelial Cell Loss Following Penetrating Keratoplasty

Author Affiliations

Author Affiliations: Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland (Dr Lass and Ms Benetz), and Cincinnati Eye Institute, Cincinnati (Dr Holland), Ohio; Jaeb Center for Health Research, Tampa, Florida (Drs Beck and Kollman and Mss Dontchev and Gal); Department of Ophthalmology and Vision Science, University of California, Davis, Sacramento (Dr Mannis); Price Vision Group, Indianapolis, Indiana (Dr Price); Ophthalmic Partners of Pennsylvania, Bala Cynwyd, Pennsylvania (Dr Raber); Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland (Dr Stark); Emory Eye Center, Emory University, Atlanta, Georgia (Dr Stulting); and W. K. Kellogg Eye Center, University of Michigan, Ann Arbor (Dr Sugar). Dr Stulting is now with the Woolfson Eye Institute, Atlanta.

Group Information: A list of the Cornea Donor Study Investigator Group members was published in Arch Ophthalmol. 2010;128(1):63-69.

Arch Ophthalmol. 2011;129(9):1149-1154. doi:10.1001/archophthalmol.2011.102

Objective To identify baseline (donor, recipient, and operative) factors that affect endothelial cell loss following penetrating keratoplasty for a moderate-risk condition (principally Fuchs dystrophy or pseudophakic or aphakic corneal edema).

Methods In a subset (n = 567) of Cornea Donor Study participants, preoperative and postoperative endothelial cell densities (ECDs) were determined by a central reading center. Multivariate regression analyses were performed to examine which baseline factors correlated with ECD over time.

Results Larger grafts (P < .001), younger donor age (P < .001), and female donor (P = .004) were significantly associated with higher ECD during follow-up. Median endothelial cell loss at 5 years was 68% for grafts larger than 8.0 to 9.0 mm in diameter, 75% for grafts 7.0 mm to smaller than 8.0 mm in diameter, and 74% for grafts 8.0 mm in diameter. Grafts from female donors experienced a 67% cell loss compared with a 72% cell loss among grafts from male donors. Method of tissue retrieval, donor cause of death, history of diabetes, and time from death to preservation or to surgery were not significantly associated with changes in ECD over time.

Conclusions Following penetrating keratoplasty for endothelial dysfunction conditions, larger donor graft size, younger donor age, and female donor were associated with higher ECD over 5 years. These data warrant exploring the possibility that similar associations may exist following endothelial keratoplasty.

Trial Registration clinicaltrials.gov Identifier: NCT00006411