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Jeremie Sahler, Matthieu Barrali, Jr., Chrystelle Vidal, Bernard Delbosc; Risks Factors For Increased Endothelial Cell Loss Post Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6449.
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In a situation of allogenic corneal, graft endothelial density is important because its reduction may lead to late endothelial failure with depletion of endothelial cells. This situation causes a functional failure and irreversible anatomic graft and requires a second transplant. The objective of this study is to define a model of endothelial decrease in our patients from the biexponential decay model described by Armitage and identify risk factors responsible of an increased endothelial cell loss in the idea of improving survival grafts.
This is a retrospective study from the corneal transplants database of the Department of Ophthalmology, Hospital of Besancon France. We have defined a model of endothelial decrease in 820 patients from the model described by Armitage. Increased endothelial cell loss is defined by a density lower than which recorded in the model: 357/820 individuals.
The mean follow-up was 2.6 (+/- 3.9) years. The average donor age was 62.4 (+/- 18.9) years. Endothelial cell density in pre-preservation was 2931 cells per mm ², 2646 in post-preservation, 1427 (n = 365) at 1 year, 995 (n = 108) at 5 years, 875 (n = 43) 10 years and 1020 (n = 11) at 15. Significant risk factors for accelerated endothelial loss in univariate analysis were: donor age> 65 years (p = 0.0219),> 75 years (p = 0.0098), duration of déturgescence <2 days (p = 0.0444), loss> 500 cells / mm ² during the conservation (p = 0.0001), scarring disorders as initial diagnosis (p = 0.0055), use of topical cyclosporine in the follow-up (p = 0.029); ablation of suture in the follow-up (p = 0.0008), immunological rejection (p = 0.0128). In multivariate analysis, significant criteria were: donor age> 80 years (p = 0.0405), duration of déturgescence < 2 days (p = 0.0225), ablation of suture (p = 0.0218).
The mean of endothelial density in our patients correspond to those found in the literature. We propose to incorporate to the selection criteria of the donor an upper age limit of 80 years, and especially because the rate of nonconformity is correlated to their age. About the selection of grafts, a limit of 500 cells / mm ² of endothelial loss during the conservation and a minimum of 2 days of déturgescence could be introduced. Similarly, an improving of the management of the intraoperative astigmatism would reduce the postoperative suture manipulation.
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