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Vincent M. Borderie, Julien Bullet, Olivier Touzeau, Pablo Goldschmidt, Laurent Laroche; Risk Factors for Endothelial Cell Loss after Corneal Transplantation. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6048.
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© ARVO (1962-2015); The Authors (2016-present)
To analyze risk factors for endothelial cell loss after corneal transplantation.
Cohort study including 1,436 consecutive eyes of 1,436 patients who underwent corneal transplantation (Penetrating Keratoplasty, Deep Anterior Lamellar Keratoplasty, or Descemet Stripping with Endothelial Keratoplasty) between 1992 and 2010. Data were prospectively recorded and then analyzed retrospectively. The main outcome measures were slit lamp examination and wide-field specular microscopy. Three models were used to describe the post-operative outcome of the corneal endothelial cell density.
In multivariate analysis, surgical technique (p<0.0001) and pre-operative diagnosis (p<0.0001) significantly influenced the early phase (EP) and late phase (LP) post-operative endothelial cell loss (ECL). The mean EP-ECL and LP-ECL were, respectively, -8.2/-4.4% per year in eyes with DALK and normal recipient endothelium, -18.9/-8.9% in eyes with PK and normal recipient endothelium, -30.0/-13.6% in eyes with PK and impaired recipient endothelium, and -56.0/-19.0% in eyes with DSEK and impaired recipient endothelium. Eyes with post-operative graft events had significantly higher EP-ECL (p<0.0001). Eyes at high risk of rejection and eyes with pre-operative hypertony had significantly higher LP-ECL (p<0.0001).
Corneal transplantation in eyes with impaired recipient endothelium is associated with high post-operative endothelial cell loss whatever the surgical technique used. The late phase cell loss after PK and DSEK is dramatically higher than the age-related cell loss. Treatments aimed at inhibiting the corneal endothelial cell death in these eyes are needed. Post-operative complications are associated with increased early cell loss. High-risk eyes and eyes with glaucoma feature increased late cell loss.
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