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Clinical Sciences
May 2013

Endothelial Morphometric Measures to Predict Endothelial Graft Failure After Penetrating Keratoplasty

Author Affiliations

Author Affiliations: Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio (Ms Benetz and Drs Lass and Menegay); Jaeb Center for Health Research, Tampa, Florida (Mss Gal and Dontchev and Drs Kollman and Beck); W. K. Kellogg Eye Center, University of Michigan, Ann Arbor (Dr Sugar); Eye Center, University of California Davis Health System, Sacramento (Dr Mannis); Cincinnati Eye Institute, Cincinnati, Ohio (Dr Holland); Gorovoy Eye Specialists, Ft Meyers, Florida (Dr Gorovoy); Wills Eye Institute, Jefferson Medical College, Philadelphia, Pennsylvania (Dr Hannush); Eye Care of San Diego, San Diego, California (Dr Bokosky); and Charleston Eye Care, Charleston, West Virginia (Dr Caudill).

Group Information: A list of the Cornea Donor Study Investigator Group members was published in Ophthalmology. 2008;115(4):620.e6-626.e6.

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

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