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A. Vong, G. W. Zaidman; Long Term Corneal Endothelial Cell Loss in Eyes With Clear Grafts After Penetrating Keratoplasty for Keratoconus. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1129.
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To measure long term endothelial cell loss (ECC) following penetrating keratoplasty (PKP) for keratoconus (KCN)
ECC was measured in eyes that had PKP from 1994-2008 for KCN. Only eyes with clear grafts were analyzed. ECC was compared to the original donor ECC. Eyes were divided into groups based on years following PKP: Group A (1-2 yrs), Group B (3-5 yrs), Group C (6-9 yrs) and Group D (10-14 yrs).We also analyzed eyes that had cataract surgery, refractive surgery, or > 2 rejection episodes after PKP.
ECC was performed on 63 eyes. Patients averaged 46 years old, ranging from 29-66 years old. Group A had 18 patients with an average cell loss of 27% +/-22% and a median cell loss of 20%.Group B had 18 patients with an average cell loss of 46% +/-16% and a median cell loss of 48%.Group C had 15 patients with an average cell loss of 56% +/-17% and a median cell loss of 59%.Group D had 12 patients with an average cell loss of 62% +/-14% and a median cell loss of 64%. 7 eyes had cataract surgery after PKP. They had a mean and median cell loss of 63% +/-13% and 63% respectively. 7 eyes had refractive surgery after PKP, with an average cell loss of 58% +/-17% and a median cell loss of 64%. 8 eyes with multiple rejection episodes following PKP had an average cell loss of 59% +/-20% and a median cell loss of 63%. The best corrected visual acuity of all eyes except 3 were 20/40 or better. 1 eye was complicated with cystoid macular edema. 2 eyes belonged to a handicapped patient who could not be refracted.
There is continuing long-term ECC loss years after PKP with the greatest loss in the first 5 years following surgery. Corneal clarity and visual acuity were not affected. Compliant patients without complicating factors had best corrected vision of 20/40 or better. Cataract surgery, refractive surgery, and resolved rejection episodes also led to continued endothelial cell loss but did not affect corneal clarity.
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