1
|
Bu JB, Grabitz SD, Schön F, Apel M, Pusch T, Gericke A, Poplawski A, Pfeiffer N, Wasielica-Poslednik J. Utility of a Model to Predict Endothelial Cell Density of Donor Corneas to Determine Suitability for Transplantation. Transl Vis Sci Technol 2024; 13:21. [PMID: 39083373 PMCID: PMC11290561 DOI: 10.1167/tvst.13.7.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 06/02/2024] [Indexed: 08/02/2024] Open
Abstract
Purpose In Germany, approximately one-third of the harvested donor corneas are not suitable for transplantation, mostly due to insufficient endothelial cell density (ECD). The ECD can only be reliably determined after harvesting and processing of the cornea. Our group has previously developed a predictive model for corneal ECD: \( {Predicted\, ECD} = 2919-6^{\ast}\;{age}\; [{years}]-189\; [{if\, male}]\\ -7^{\ast}\;{death-to-explantation\, interval\,} [{hours}]\\ - 378\; [{if\, pseudophakic}] \;{cells/mm}^2 \). Methods A total of 2.999 consecutive donor corneas harvested between 2017 and 2021 from the Eye Bank of Rhineland-Palatinate in Mainz, Germany, were included. An actual ECD of >2000 cells/mm2 was defined as the cutoff value. To evaluate the clinical utility of the prognostic model as a screening instrument for transplant eligibility in an independent cohort, we performed a decision curve analysis. Results The median predicted ECD was 2061 cells/mm2 (interquartile range [IQR] = 1834 to 2221), whereas the median actual ECD was 2377 cells/mm2 (IQR = 1907 to 2624). There was a positive correlation between predicted and actual ECD (correlation coefficient = 0.411; P < 0.01). Our predictive model for ECD is a strong predictor for an actual ECD greater than 2000 (odds ratio = 1.374, 95% confidence interval [CI]) per 100 cells; P < 0.001, area under the curve [AUC] of 0.73). Decision curve analysis showed that the predictive model yielded a positive net benefit in clinical settings. Conclusions Decision curve analysis demonstrated a positive net benefit of the ECD predictive model in clinical settings with limited eye bank resources. Translational Relevance In possible scenarios where a choice between corneal grafts is required, or in countries with limited eye bank infrastructure and staff, the initial estimate of ECD from the formula may be beneficial.
Collapse
Affiliation(s)
- Julia B. Bu
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Stephanie D. Grabitz
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Franziska Schön
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Melissa Apel
- Eye Bank of Rhineland-Palatinate, Koblenz, Germany
| | - Tobias Pusch
- Eye Bank of Rhineland-Palatinate, Koblenz, Germany
| | - Adrian Gericke
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Alicia Poplawski
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Joanna Wasielica-Poslednik
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| |
Collapse
|
2
|
Kitazawa K, Toda M, Ueno M, Wakimasu K, Tomioka Y, Uehara A, Sotozono C, Kinoshita S. Donor Corneal Endothelial Cell Maturity and Its Impact on Graft Survival in Glaucoma Patients Undergoing Corneal Transplantation. Am J Ophthalmol 2024; 262:1-9. [PMID: 38307212 DOI: 10.1016/j.ajo.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 08/28/2023] [Accepted: 01/25/2024] [Indexed: 02/04/2024]
Abstract
PURPOSE To examine corneal graft survival via corneal endothelial cell density (ECD) and corneal endothelial cell loss (ECL) at 5 years post-transplantation in the eyes of patients with and without a history of undergoing glaucoma surgery according to the maturity of the donor corneal endothelial cells. DESIGN Prospective cohort study. METHODS This prospective cohort study included 17 patients with glaucoma and 51 patients without glaucoma who underwent Descemet's stripping automated endothelial keratoplasty or penetrating keratoplasty at the Baptist Eye Institute, Kyoto, Japan, between October 2014 and October 2016. Human corneal endothelial cells were cultured from residual peripheral donor cornea tissue, and the maturity of the cells was evaluated by cell surface markers (ie, CD166+, CD44-/dull, CD24-, and CD105-) using fluorescence-activated cell sorting. Kaplan-Meier analysis or the chi-square test was used to assess the rate of successful corneal graft survival post-transplantation. RESULTS At 36 months postoperatively, the mean ECD and ECL in the glaucoma-bleb eyes were 1197 ± 352 cells/mm2 and 55.5% ± 13.9% in the high-maturity group and 853 ± 430 cells/mm2 and 67.7% ± 18.1% in the low-maturity group, respectively. Kaplan-Meier analysis revealed that at 5 years postoperatively, the overall rate of survival was 45%, that is, 100% in the high-maturity group and 25% in the low-maturity group (P < .05). CONCLUSIONS The findings in this prospective cohort study revealed that the use of donor corneal grafts containing mature-differentiated corneal endothelial cells could maintain the survival of the transplanted graft for a long-term period, even in patients with a history of undergoing glaucoma surgery.
Collapse
Affiliation(s)
- Koji Kitazawa
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.); Department of Ophthalmology, Baptist Eye Institute, Kyoto, Japan (K.K., K.W., C.S., S.K.)
| | - Munetoyo Toda
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.); Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (M.T., S.K.)
| | - Morio Ueno
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.)
| | - Koichi Wakimasu
- Department of Ophthalmology, Baptist Eye Institute, Kyoto, Japan (K.K., K.W., C.S., S.K.)
| | - Yasufumi Tomioka
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.)
| | - Asako Uehara
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.)
| | - Chie Sotozono
- From the Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (K.K., M.T., M.U., Y.T., A.U., C.S.); Department of Ophthalmology, Baptist Eye Institute, Kyoto, Japan (K.K., K.W., C.S., S.K.)
| | - Shigeru Kinoshita
- Department of Ophthalmology, Baptist Eye Institute, Kyoto, Japan (K.K., K.W., C.S., S.K.); Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan (M.T., S.K.).
| |
Collapse
|
3
|
Kounatidou NE, Kopsini D, Gibbons A, Crane AM, Palioura S, Alfonso EC. Semi-Autologous Corneal Transplantation with Simultaneous Bilateral Surgery: A Case Report. Case Rep Ophthalmol 2023; 14:439-447. [PMID: 37901627 PMCID: PMC10601773 DOI: 10.1159/000531990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/29/2023] [Indexed: 10/31/2023] Open
Abstract
The present report describes a case of semi-autologous corneal transplantation with bilateral surgery using two operating microscopes simultaneously. An 86-year-old man with history of six prior failed penetrating keratoplasties in his right eye presented with decreased vision. His other eye was deeply amblyopic but had a clear 30-year-old Castroviejo-square graft with an endothelial cell count of 803 cells/mm2. A semi-autologous graft was performed from the left eye to the right. Surgery was performed simultaneously on both eyes by two different surgeons using a standard ophthalmic operating microscope as well as a second ENT microscope. Upon trephination of the right failed corneal graft, vitreous opacities were noted and sent for culture. The semi-autologous tissue was directly transferred from the left eye to the right without any storage in preservation media to avoid endothelial cell loss. The semi-autologous graft remained clear in the immediate postoperative period. However, the vitreous cultures grew coagulase-negative Staphylococcus. Despite all efforts, the patient eventually developed a retinal detachment and vision in the right eye decreased to light perception. Autologous penetrating keratoplasty is an option for patients with loss of corneal function in a potentially seeing eye and a clear cornea in a contralateral eye with poor visual potential due to non-corneal disease. This case is unique in that part of the autologous penetrating keratoplasty had an old square graft in the center and corneal transplant surgery was done simultaneously in both eyes. It also highlights chronic indolent endophthalmitis as a potential cause of multiple graft failures.
Collapse
Affiliation(s)
- Nefeli E. Kounatidou
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Allister Gibbons
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ashley M. Crane
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Sotiria Palioura
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Eduardo C. Alfonso
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
4
|
Kitazawa K, Toda M, Ueno M, Uehara A, Sotozono C, Kinoshita S. The Biologic Character of Donor Corneal Endothelial Cells Influences Endothelial Cell Density Post Successful Corneal Transplantation. OPHTHALMOLOGY SCIENCE 2022; 3:100239. [PMID: 36846106 PMCID: PMC9944567 DOI: 10.1016/j.xops.2022.100239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/07/2022]
Abstract
Purpose Corneal endothelial cell density (ECD) gradually decreases after corneal transplantation by unknown biologic, biophysical, or immunologic mechanism. Our purpose was to assess the association between donor corneal endothelial cell (CEC) maturity in culture and postoperative endothelial cell loss (ECL) after successful corneal transplantation. Design Prospective cohort study. Participants This cohort study was conducted at Baptist Eye Institute, Kyoto, Japan, between October 2014 and October 2016. It included 68 patients with a 36-month follow-up period who had undergone successful Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty. Methods Human CECs (HCECs) from remaining peripheral donor corneas were cultured and evaluated for maturity by surface markers (CD166+, CD44-/dull, CD24-, and CD105-) using fluorescence-activated cell sorting. Postoperative ECD was assessed according to the mature-differentiated HCEC contents: high-maturity group: > 70%, middle-maturity group: 10% to 70%, low-maturity group: < 10%. The successful rate of ECD maintained at 1500 cells/mm2 at 36 months postoperative was analyzed using the log-rank test. Main Outcome Measures Endothelial cell density and ECL at 36 months postoperative. Results The 68 included patients (mean [standard deviation] age 68.1 [13.6] years, 47.1% women, 52.9% DSAEK). The high, middle, and low-maturity groups included 17, 32, and 19 eyes, respectively. At 36 months postoperative, the mean (standard deviation) ECD significantly decreased to 911 (388) cells/mm2 by 66% in the low-maturity group, compared with 1604 (436) by 40% and 1424 (613) cells/mm2 by 50% in the high and middle-maturity groups (P < 0.001 and P = 0.007, respectively) and the low-maturity group significantly failed to maintain ECD at 1500 cells/mm2 at 36 months postoperative (P < 0.001). Additional ECD analysis for patients who underwent DSAEK alone displayed a significant failure to maintain ECD at 1500 cells/mm2 at 36 months postoperative (P < 0.001). Conclusions The high content of mature-differentiated HCECs expressed in culture by the donor peripheral cornea was coincident with low ECL, suggesting that a high-maturity CEC content predicts long-term graft survival. Understanding the molecular mechanism for maintaining HCEC maturity could elucidate the mechanism of ECL after corneal transplantation and aid in developing effective interventions. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
Collapse
Key Words
- BK, bullous keratopathy
- CEC, corneal endothelial cell
- Corneal endothelial cell density
- Corneal transplantation
- Cultured corneal endothelial cells
- DSAEK
- DSAEK, Descemet stripping automated endothelial keratoplasty
- ECD, endothelial cell density
- ECL, endothelial cell loss
- Endothelial cell loss
- FACS, fluorescence-activated cell sorting
- HCEC, human CEC
- P, passage
- PK, penetrating keratoplasty
- SD, standard deviation
Collapse
Affiliation(s)
- Koji Kitazawa
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan,Baptist Eye Institute, Kyoto, Japan
| | - Munetoyo Toda
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Morio Ueno
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Asako Uehara
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Chie Sotozono
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan,Baptist Eye Institute, Kyoto, Japan
| | - Shigeru Kinoshita
- Baptist Eye Institute, Kyoto, Japan,Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan,Correspondence: Shigeru Kinoshita, MD, PhD, 465 Kajii-cho, Hirokoji-agaru, Kawaramachi-dori, Kamigyo-ku, Kyoto 602-0841, Japan.
| |
Collapse
|
5
|
Xu TT, Cao R, Dong YL, Xie LX, Cheng J. Analysis of risk factors of rapid attenuation of graft endothelium in the early stage after penetrating keratoplasty. PLoS One 2022; 17:e0266072. [PMID: 35381040 PMCID: PMC8982837 DOI: 10.1371/journal.pone.0266072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/25/2021] [Indexed: 01/27/2023] Open
Abstract
This study aimed to analyze the factors of rapid attenuation of graft endothelium in the early stage after penetrating keratoplasty (PKP), with a view to guiding patients with PKP to better long-term outcomes. This study included 226 patients who underwent PKP with follow-up time >1 year at the Qingdao Eye Hospital of Shandong First Medical University from January 2018 to June 2020. Medical records were retrospectively studied, and donor factors, patient factors, and surgical factors were comparatively analyzed to clarify those affecting the rapid decay of graft endothelium after PKP. The median time between excision and death >60 min and patient age >60 years were risk factors for endothelial cell loss (ECL) rate >30% at 1 month postoperatively. However, a higher percentage of patients with donor age ≤60 years and Optisol preservation solution had endothelial cell density (ECD) >2000 cells/mm2 in the graft at postoperative 1 year. A year after the surgery, patients with corneal endothelial decompensation and immune rejection were at risk for ECD < 1000 cells/mm2. The combined operations had a significant effect on the ECL in the early postoperative period. Patients who underwent combined extracapsular cataract extraction or intraocular lens implantation had a significantly higher rate of ECL at postoperative 1 month than other patients, and no significant effect at postoperative 1 year. However, patients without combined operations have a higher probability of maintaining a high level of graft ECD. The graft diameter also affected postoperative ECL. In patients with a larger graft diameter, attenuation of ECD was slower. The ultimate goal of PKP is to maintain graft transparency for extended periods. The use of younger donors, minimizing unnecessary operation in the anterior chamber, and minimizing immune rejection may maintain a greater donor corneal endothelium in the long term.
Collapse
Affiliation(s)
- Ting-ting Xu
- Weifang Medical University, Institute of Clinical Medicine, Weifang, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
| | - Rui Cao
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Yan-ling Dong
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Li-xin Xie
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
| | - Jun Cheng
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Qingdao, China
- Eye Institute of Shandong First Medical University, Qingdao Eye Hospital of Shandong First Medical University, Qingdao, China
- School of Ophthalmology, Shandong First Medical University, Jinan, China
- * E-mail:
| |
Collapse
|
6
|
Abstract
PURPOSE To investigate the key factors associated with eyes with an endothelial cell density (ECD) of ≥2000 cells/mm at 5 years after corneal transplantation. METHODS This retrospective cohort study included 174 eyes that underwent penetrating keratoplasty by 1 corneal specialist surgeon at the Baptist Eye Institute, Kyoto, Japan, from 1998 through 2011 and that were carefully followed for over 5 years postoperative. In all operated eyes, corneal ECD was measured at 1, 2, 3, 4, and 5 years postoperative. Multivariate analysis with adjustment for preoperative donor ECD was performed between eyes with an ECD of ≥2000 cells/mm and those with an ECD of <2000 cells/mm at 5 years postoperative. RESULTS Of the 174 eligible eyes, 16 eyes (9.2%) had an ECD of ≥2000 cells/mm at 5 years postoperative, and the annual rate of endothelial cell loss (mean ± SD) was 2.3% ± 3.7%. Multivariate analysis findings revealed that the donor-associated and surgery-related factors were not significant factors. Only the recipient diagnosis of bullous keratopathy was significantly associated with an ECD of <2000 cells/mm at 5 years postoperative. Of those 16 eyes, 6 (37.5%) had a recipient diagnosis of bullous keratopathy. CONCLUSIONS None of the donor- and surgery-related factors, previously recognized as associated with a lower endothelial cell loss after penetrating keratoplasty, were found to be significant in this study, thus suggesting that there are still unknown factors associated with maintaining a higher ECD over the long-term postoperative period.
Collapse
|
7
|
How to Predict the Suitability for Corneal Donorship? J Clin Med 2021; 10:jcm10153426. [PMID: 34362207 PMCID: PMC8347780 DOI: 10.3390/jcm10153426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/26/2021] [Accepted: 07/30/2021] [Indexed: 01/24/2023] Open
Abstract
Background: In Germany, more than one-third of donor corneas harvested are not suitable for transplantation. We evaluated the factors associated with the usability of donor corneas. Method: Data from 2032 consecutive donor corneas harvested at the Rhineland-Palatinate Eye Bank in Mainz, Germany, were retrospectively analyzed. Factors of interest were age, sex, lens status, cause of death, cardiopulmonary resuscitation (CPR), death-to-explantation-interval (DEI), and the influence of these factors on the proportion of discarded donor corneas. Factors associated with endothelial cell density (ECD) were analyzed in a linear regression mixed model. Results: Higher donor age, male gender, pseudophakic lens status, and longer DEI were associated with significantly reduced ECD. With respect to DEI, the estimated cell loss was 7 ± 2 cells/mm2/hour (p < 0.001). Age was associated with a lower ECD of 6 ± 2 cells/mm2 per year (p = 0.001). Female ECD was 189 ± 44 cells/mm2 higher than male ECD (p < 0.001). Pseudophakic eyes had 378 ± 42 cells/mm2 less compared with phakic eyes (p < 0.001). Cause of death did not affect the ECD. Of note, 55% and 38% of corneas harvested on the second and third postmortem day, respectively, and 45% of corneas from donors older than 80 years were still suitable for transplantation. Conclusions: In the context of a growing need for donor corneas, we do not recommend limiting donor age and collection time to 24 h or excluding oncology donors, as is the practice in many countries. Therefore, we propose a mathematical model for better donor preselection.
Collapse
|
8
|
Brand J, Langenbucher A, Zemova E, Stachon T, Weber M, Rebmann J, Seitz B, Szentmáry N. Impact of Pre- and Intraoperative Factors on Endothelial Cell Density in the Early and Late Stage after Penetrating Keratoplasty. Klin Monbl Augenheilkd 2021; 238:904-911. [PMID: 34000746 DOI: 10.1055/a-1333-2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM This retrospective investigated the impact of donor age, recipient age, donor endothelial cell density, vis-à-tergo, and additional intraoperative lens exchange (triple-procedure) on overall early and late phase postoperative endothelial cell density (ECD) following penetrating keratoplasty (PKP) in various diagnosis groups. PATIENTS AND METHODS In 590 cases with diagnosed keratoconus (KC), Fuchs dystrophy (FD) and herpes simplex virus infection (HSV) who underwent PKP or triple surgery, the ECD in cells/mm2 was analysed, both preoperatively, with all-sutures-in (early postoperative stage), and after last suture removal. The factors were tested by Mann-Whitney U-test, correlation analysis and linear regression analysis. OUTCOME Correlation analysis demonstrated a weak negative correlation between the patient's ECD and donor age (early postoperative stage: r = - 0.25, p < 0.001; after last suture removal: r = - 0.16; p = 0.003). Regression analysis revealed that donor age did not impact postoperative patient ECD. There was a weak negative correlation between postoperative ECD and recipient age (early postoperative stage: r = - 0.31, p < 0.001; after last suture removal: r = - 0.34, p < 0.001). Regression analysis confirmed the negative impact of recipient age on patient ECD (early postoperative stage: β = - 13.2, p = 0.001; after last suture removal: β = - 4.6, p < 0.001). Correlation analysis determined a weak positive correlation between postoperative ECD and donor endothelial cell density (early postoperative stage: r = 0.37, p < 0.001; after last suture removal: r = 0.32, p < 0.001). Regression analysis also determined that donor endothelial cell density had a positive impact on postoperative ECD following last suture removal (β = 0.4, p < 0.001). Vis-à-tergo and additional lens exchange (triple procedure) had no significant effect on postoperative ECD (p > 0.05). This was also confirmed by the results of the regression analysis after last suture removal. CONCLUSION Recipient age and donor endothelial cell density have a significant impact on postoperative ECD following PKP. Not all of the statistical tests proved donor age to be a significant influencing factor. Vis-à-tergo and additional lens exchange (triple procedure) had no significant effect on postoperative ECD following PKP.
Collapse
Affiliation(s)
- Jessica Brand
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Achim Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - Elena Zemova
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Tanja Stachon
- Dr. Rolf M. Schwiete Zentrum für Limbusstammzellforschung und kongenitale Aniridie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - Melanie Weber
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Jerome Rebmann
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Zentrum für Limbusstammzellforschung und kongenitale Aniridie, Universität des Saarlandes, Homburg/Saar, Deutschland.,Klinik für Augenheilkunde, Semmelweis Universität, Budapest, Ungarn
| |
Collapse
|
9
|
Qu JH, Peng RM, Xiao GG, Qu HQ, Yu T, Zhang S, Hong J. Loss of endothelial cells in viral DNA-positive grafts after keratoplasty: a 2-year follow-up study. Br J Ophthalmol 2020; 106:26-31. [PMID: 33055089 PMCID: PMC8685643 DOI: 10.1136/bjophthalmol-2020-317629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND To compare endothelial loss between recipients who received viral DNA-positive grafts and controls 2 years after corneal transplantation. METHODS We retrospectively analysed the clinical data and endothelial cell density of recipients of viral DNA-positive grafts and age-, sex-, aetiology- and operation-matched controls from April 2017 to July 2019 at the Peking University Third Hospital, Beijing, China. RESULTS A total of 23/942 (2.44%) donor corneal buttons tested virus-positive by real-time PCR. A total of 27 recipients (except for 2 recipients) of viral DNA-positive grafts and 48 recipients of viral DNA-negative grafts were included in this study. Recipients of viral DNA-positive grafts had a higher endothelial cell (EC) loss rate post-penetrating keratoplasty and post-descemet stripping automated endothelial keratoplasty (p<0.05), but post-deep lamellar keratoplasty, the EC loss rate was similar to that of the controls. Recipients of herpes simplex virus-1-, cytomegalovirus- and varicella-zoster virus-positive grafts all had a higher EC loss rate than the controls during the 12- and 24-month follow-up periods (p<0.05). CONCLUSION We inferred that viruses might be hidden in corneal grafts and mainly incubate in the corneal endothelium. Viral DNA-positive grafts do not need to be replaced immediately and can be followed up for a long time.
Collapse
Affiliation(s)
- Jing-Hao Qu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Rong-Mei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Ge-Ge Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Hong-Qiang Qu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Ting Yu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Shuang Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China .,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
| |
Collapse
|
10
|
Alio JL, Montesel A, El Sayyad F, Barraquer RI, Arnalich-Montiel F, Alio Del Barrio JL. Corneal graft failure: an update. Br J Ophthalmol 2020; 105:1049-1058. [DOI: 10.1136/bjophthalmol-2020-316705] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/29/2020] [Accepted: 07/03/2020] [Indexed: 11/04/2022]
Abstract
Corneal graft surgery is one of the most successful forms of human solid-tissue transplantation, and nowadays, there is a worldwide expansion of the surgical volume of corneal grafts. This surgery is continuously evolving, with new surgical techniques and postoperative treatments that have considerably increased the chance of survival for the grafts. Despite the high rate of success, corneal transplantation is still complicated by a relevant risk of graft failure. This study investigates the causes that lead to the failure of the different corneal graft surgical techniques and provides an updated synthesis on this topic. A comprehensive review of the main pathological pathways that determine the failure of corneal grafts is provided, analysing the main risk factors and disclosing the survival rates of the principal form of corneal grafts. Our results revealed that penetrating keratoplasty has higher failure rates than lamellar keratoplasty, with immunological rejection being the leading cause of graft failure, followed by late endothelial failure (LEF) and ocular surface disorders. Postoperative glaucoma and dehiscence of the surgical wound represent other important causes of failure. Endothelial keratoplasty showed the lowest rates of failure in the mid-term, with LEF, detachment of the graft and primary graft failure representing the most common pathological reasons for failure.
Collapse
|
11
|
Discrepancies in Endothelial Cell Density Values of Human Donor Corneas Resulting From Comparison Between Specular Microscopes and Endothelial Analysis Methods. Cornea 2019; 39:495-500. [PMID: 31738243 DOI: 10.1097/ico.0000000000002208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The methods for specular microscopy evaluation across eye banks differ, which may result in variability in endothelial cell density (ECD) values that influence the surgeon's decision about donor tissue. A comparison of instruments and analysis methods is conducted in this study. METHODS Specular images were captured from 97 donor corneas using both HAI and Konan specular microscopes. A single best quality image of each cornea from each instrument was graded using the respective inherent software and analysis method (HAI: variable frame method; Konan: center method). All raw specular images were standardized for dimensions and regraded in the CellChek system in a blinded fashion. The grading variances and paired t test were performed between instruments in both inherent and standardized analyses. Correlation and Bland-Altman analyses between instruments were also performed. RESULTS Using the software inherent within HAI and Konan, the mean ECD readings for the 97 corneas were 2764 ± 583 and 2605 ± 517 cell/mm (P = 0.045), respectively, with a variance of 8.05% (range 0.26%-27.2%). HAI resulted in a higher ECD value in 79 corneas (81.4%). In CellChek software analysis, the mean ECD readings did not differ (2609 ± 514 and 2496 ± 507 cells/mm, respectively, P = 0.127), with a variance of 5.6% (range 0.24%-19.8%). CONCLUSIONS There is a slight statistically significant mean difference between the ECD values obtained from the 2 specular microscopes, which is negated by standardization to a single analysis method. Eye banks and surgeons should use caution in making decisions based only on very small differences in ECD between otherwise equivalent corneal donor tissues.
Collapse
|
12
|
Lass J, Benetz BA, Verdier DD, Szczotka-Flynn LB, Ayala AR, Liang W, Aldave AJ, Dunn SP, McCall T, Mian SI, Navarro LC, Patel SV, Pramanik S, Rosenwasser GO, Ross KW, Terry MA, Kollman C, Gal RL, Beck RW. Corneal Endothelial Cell Loss 3 Years After Successful Descemet Stripping Automated Endothelial Keratoplasty in the Cornea Preservation Time Study: A Randomized Clinical Trial. JAMA Ophthalmol 2019; 135:1394-1400. [PMID: 29127432 DOI: 10.1001/jamaophthalmol.2017.4970] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Importance Demonstrating that endothelial cell loss following Descemet stripping automated endothelial keratoplasty (DSAEK) is independent of donor cornea preservation time (PT) could increase the pool of corneal tissue available for keratoplasty. Objective To determine whether endothelial cell loss 3 years after successful DSAEK is related to PT. Design, Setting, and Participants A multicenter, double-masked, randomized clinical trial included 40 clinical sites (70 surgeons) in the United States, with donor corneas provided by 23 US eye banks. A total of 945 eyes of 769 participants were included in the Cornea Preservation Time Study that had not experienced graft failure 3 years after DSAEK, performed primarily for Fuchs endothelial corneal dystrophy (96% of the cohort). The study was conducted from April 16, 2012, to June 5, 2017. Interventions DSAEK with random assignment of a donor cornea with PT of 0 to 7 days (0-7d PT) or 8 to 14 days (8-14d PT). Main Outcomes and Measures Endothelial cell density (ECD) at 3 years determined by a central image analysis reading center from clinical specular or confocal central endothelial images. Results Nine hundred forty-five eyes of 769 participants (median age, 70 years [range, 42-90 years], 60.8% women, 93.0% white) in the Cornea Preservation Time Study that had not experienced graft failure 3 years after DSAEK were included. At the initial eye bank tissue screening, mean (SD) central ECD was 2746 (297) cells/mm2 in the 0-7d PT group (n = 485) and 2723 (284) cells/mm2 in the 8-14d PT group (n = 460). At 3 years, the mean (SD) ECD decreased from baseline by 37% (21%) in the 0-7d PT group and 40% (22%) in the 8-14d PT group to 1722 (626) cells/mm2 and 1642 (631) cells/mm2, respectively (mean difference, 73 cells/mm2; 95% CI, 8-138 cells/mm2; P = .03). When analyzed as a continuous variable (days), longer PT was associated with lower ECD (mean difference by days, 15 cells/mm2; 95% CI, 4-26 cells/mm2; P = .006). Endothelial cell loss (ECL) was comparable from 4 to 13 days’ PT (n = 878; 36%-43% when tabulated by day). Available extension study ECD results at 4 years mirrored those at 3 years in the 203 eyes in the 0-7d PT group (mean [SD] ECD, 1620 [673] cells/mm2 and mean [SD] ECL, 41% [23%]) and 209 eyes in the 8-14d PT group (mean [SD] ECD, 1537 [683] cells/mm2 and mean [SD] ECL, 44% [23%]) (mean difference, 112 cells/mm2; 95% CI, 5-219 cells/mm2; P = .04). Conclusions and Relevance Although ECL 3 years after Descemet stripping automated endothelial keratoplasty is greater with longer PT, the effect of PT on ECL is comparable from 4 to 13 days’ PT.
Collapse
Affiliation(s)
- Jonathan Lass
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio,University Hospitals Cleveland Medical Center, Cleveland, Ohio,Cornea Image Analysis Reading Center, Cleveland, Ohio
| | - Beth Ann Benetz
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio,University Hospitals Cleveland Medical Center, Cleveland, Ohio,Cornea Image Analysis Reading Center, Cleveland, Ohio
| | | | - Loretta B Szczotka-Flynn
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University, Cleveland, Ohio,University Hospitals Cleveland Medical Center, Cleveland, Ohio,Cornea Image Analysis Reading Center, Cleveland, Ohio
| | | | - Wendi Liang
- Jaeb Center for Health Research, Tampa, Florida
| | - Anthony J Aldave
- Stein Eye Institute, UCLA (University of California, Los Angeles)
| | | | | | | | | | - Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | | | | | | | | | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
| | | |
Collapse
|
13
|
Hori J, Yamaguchi T, Keino H, Hamrah P, Maruyama K. Immune privilege in corneal transplantation. Prog Retin Eye Res 2019; 72:100758. [PMID: 31014973 DOI: 10.1016/j.preteyeres.2019.04.002] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/14/2019] [Accepted: 04/16/2019] [Indexed: 12/13/2022]
Abstract
Corneal transplantation is the most successful solid organ transplantation performed in humans. The extraordinary success of orthotopic corneal allografts, in both humans and experimental animals, is related to the phenomenon of "immune privilege". Inflammation is self-regulated to preserve ocular functions because the eye has immune privilege. At present, three major mechanisms are considered to provide immune privilege in corneal transplantation: 1) anatomical, cellular, and molecular barriers in the cornea; 2) tolerance related to anterior chamber-associated immune deviation and regulatory T cells; and 3) an immunosuppressive intraocular microenvironment. This review describes the mechanisms of immune privilege that have been elucidated from animal models of ocular inflammation, especially those involving corneal transplantation, and its relevance for the clinic. An update on molecular, cellular, and neural interactions in local and systemic immune regulation is provided. Therapeutic strategies for restoring immune privilege are also discussed.
Collapse
Affiliation(s)
- Junko Hori
- Department of Ophthalmology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan; Department of Ophthalmology, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama, Tokyo, 206-8512, Japan.
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan; Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Keino
- Department of Ophthalmology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan
| | - Pedram Hamrah
- Center for Translational Ocular Immunology, Tufts Medical Center, Tufts University School of Medicine, Tufts University, 800 Washington St, Boston, MA, 02111, USA; Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Tufts University, 800 Washington St, Boston, MA, 02111, USA
| | - Kazuichi Maruyama
- Department of Innovative Visual Science, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| |
Collapse
|
14
|
Yazu H, Yamaguchi T, Tsubota K, Shimazaki J. Clinical Factors for Rapid Endothelial Cell Loss After Corneal Transplantation: Novel Findings From the Aqueous Humor. CURRENT OPHTHALMOLOGY REPORTS 2019. [DOI: 10.1007/s40135-019-00204-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
15
|
Lass JH, Benetz BA, Patel SV, Szczotka-Flynn LB, O’Brien R, Ayala AR, Maguire MG, Daoud YJ, Greiner MA, Hannush SB, Lee WB, Mauger TF, Menegay HJ, Mifflin MD, Raizman MB, Rose-Nussbaumer J, Schultze RL, Schmidt GA, Sugar A, Terry MA, Verdier DD. Donor, Recipient, and Operative Factors Associated With Increased Endothelial Cell Loss in the Cornea Preservation Time Study. JAMA Ophthalmol 2019; 137:185-193. [PMID: 30422157 PMCID: PMC6439830 DOI: 10.1001/jamaophthalmol.2018.5669] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/26/2018] [Indexed: 12/19/2022]
Abstract
Importance Determining factors associated with endothelial cell loss after Descemet stripping automated endothelial keratoplasty (DSAEK) could improve long-term graft survival. Objective To evaluate the associations of donor, recipient, and operative factors with endothelial cell density (ECD) 3 years after DSAEK in the Cornea Preservation Time Study. Design, Setting, and Participants This cohort study was a secondary analysis of data collected in a multicenter, double-masked, randomized clinical trial. Forty US clinical sites with 70 surgeons participated, with donor corneas provided by 23 US eye banks. Individuals undergoing DSAEK for Fuchs dystrophy or pseudophakic/aphakic corneal edema were included. Interventions The DSAEK procedure, with random assignment of a donor cornea with a preservation time of 0 to 7 days or 8 to 14 days. Main Outcomes and Measures Endothelial cell density at 3 years as determined by a reading center from eye bank and clinical specular or confocal central endothelial images. Results The study included 1090 participants (median age, 70 years) with 1330 affected eyes (240 bilateral cases [22.0%]), who underwent DSAEK for Fuchs dystrophy (1255 eyes [94.4%]) or pseudophakic/aphakic corneal edema (PACE) (75 eyes [5.6%]). Of these, 801 eyes (60.2%) belonged to women and 1207 (90.8%) to white individuals. A total of 749 participants (913 eyes; 164 [21.9%] bilateral cases) had functioning grafts with acceptable endothelial images preoperatively and at 3 years postoperatively and were included in this analysis. Factors associated with a lower ECD at 3 years (estimated effect with 99% CI) in the final multivariable model included donors with diabetes (-103 [-196 to -9] cells/mm2), lower screening ECD (-234 [-331 to -137] per 500 cells/mm2), recipient diagnosis of PACE (-257 [-483 to -31] in cells/mm2), and operative complications (-324 [-516 to -133] in cells/mm2). Endothelial cell loss (ECL) from a preoperative measurement to a 3-year postoperative measurement was 47% (99% CI, 42%-52%) for participants receiving tissue from donors with diabetes vs 43% (99% CI, 39%-48%) without diabetes; it was 53% (99% CI, 44%-62%) for participants diagnosed with PACE vs 44% (99% CI, 39%-49%) for those diagnosed with Fuchs dystrophy, and 55% (99% CI, 48%-63%) in participants who experienced operative complications vs 44% (99% CI, 39%-48%) in those who did not. No other donor, recipient, or operative factors were significantly associated with 3-year ECD. Conclusions and Relevance Donor diabetes, lower screening ECD, a PACE diagnosis in the recipient, and operative complications were associated with lower ECD at 3 years after DSAEK surgery and may be associated with long-term graft success. While causation cannot be inferred, further studies on the association of donor diabetes and PACE in recipients with lower 3-year ECD warrant further study.
Collapse
Affiliation(s)
- Jonathan H. Lass
- Cornea Image Analysis Reading Center, Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
| | - Beth Ann Benetz
- Cornea Image Analysis Reading Center, Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
| | - Sanjay V. Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - Loretta B. Szczotka-Flynn
- Cornea Image Analysis Reading Center, Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Maureen G. Maguire
- Center for Preventive Ophthalmology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Yassine J. Daoud
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - Thomas F. Mauger
- The Ohio State University Wexner Medical Center-Havener Eye Institute, Columbus
| | - Harry J. Menegay
- Cornea Image Analysis Reading Center, Department of Ophthalmology and Visual Sciences, University Hospitals Eye Institute, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | - Alan Sugar
- Kellogg Eye Center, University of Michigan, Ann Arbor
| | | | | |
Collapse
|
16
|
Risk Factors for Endothelial Decompensation after Penetrating Keratoplasty and Its Novel Therapeutic Strategies. J Ophthalmol 2018; 2018:1389486. [PMID: 30581601 PMCID: PMC6276470 DOI: 10.1155/2018/1389486] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/01/2018] [Accepted: 10/17/2018] [Indexed: 01/01/2023] Open
Abstract
Purpose To review the risk factors and pathogenesis of endothelial decompensation after penetrating keratoplasty (PKP) and its novel therapeutic strategies. Methods Literature review. Results As the major cause of graft failure in PKP, endothelial decompensation of corneal allograft is considered an irreversible decrease in endothelial cell density and endothelial dysfunction. Various risk factors, including donor status and operative and recipient factors, have been found to be associated with this pathological process. Operative factors like graft size and recipient factors such as indications, glaucoma, or glaucoma surgery history are highly associated with the occurrence of endothelial decompensation, while others are still under investigation. Although the mechanism of these risk factors remains unclear, pathogenesis can be summarized as an acute and chronic loss of endothelium, and cell exchange between donor and recipient is at the core of chronic cell loss. Endothelial keratoplasty has been a useful alternative to repeat standard PKP in eyes with failed grafts. Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet's membrane endothelial keratoplasty (DMEK) following failed PKP provide more rapid visual recovery and achieve better rates of graft survival than those of a second PKP. Conclusions Any direct or indirect damage to the endothelium could cause the loss, morphological changes, and dysfunction of endothelial cells. Graft size, indications, and recipient glaucoma or glaucoma surgery history are risk factors for endothelial decompensation. DSAEK and DMEK are novel therapeutic strategies for failed PKP grafts and have potential superiorities compared with repeat PKP.
Collapse
|
17
|
[Influence of the donor age on graft survival : Is the demographic change also important for corneal tissue donation?]. Ophthalmologe 2018; 114:440-444. [PMID: 27785556 DOI: 10.1007/s00347-016-0381-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The success of corneal transplantation highly depends on the quality of the used graft. Various factors play a crucial role such as a perfect stroma without optically relevant, centrally located cloudiness or changes (e. g. scars) or an adherent Descemet membrane. One of the most important parameters is the quality of the endothelial cell layer with a sufficiently large endothelial cell count. An open question is so far whether the donor age affects corneal quality and therefore has an impact on the success of transplantation. A comprehensive review of the available literature revealed that a large amount of scientific data on the influence of donor age exist to answer this question. In a variety of studies, no significant dependence of graft quality of donor age could be detected. Rather the studies prove that graft survival depends primarily on the state of the endothelial cell layer, and postoperative endothelial cell loss must be considered as a major cause of graft failure. Extensive quality assurance procedures in tissue preparation and cornea processing in the eye banks in Germany (Europe) ensures that only corneas with tested high quality are allocated for transplantation regardless of the donor age. Against the background of an aging population, the use of grafts from older donors should not be waived.
Collapse
|
18
|
Yagi-Yaguchi Y, Yamaguchi T, Higa K, Suzuki T, Aketa N, Dogru M, Satake Y, Shimazaki J. Association between corneal endothelial cell densities and elevated cytokine levels in the aqueous humor. Sci Rep 2017; 7:13603. [PMID: 29051590 PMCID: PMC5648880 DOI: 10.1038/s41598-017-14131-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 10/06/2017] [Indexed: 12/17/2022] Open
Abstract
Annual reduction rate of corneal endothelial cell density (ECD) varies among etiologies, however, the cause of chronic endothelial cell loss is still unknown. We recently reported the elevation of inflammatory cytokines in the aqueous humor (AqH) in eyes with bullous keratopathy and low ECD. To evaluate the association between ECD and aqueous cytokine levels, we collected a total of 157 AqH samples prospectively. The AqH levels of cytokines were measured and multivariate analyses were conducted to find the correlation between ECD, aqueous cytokine levels and clinical factors, such as number of previous intraocular surgeries and protein concentration in AqH. As a result, ECD was negatively correlated with specific cytokine levels, including IL-1α, IL-4, IL-13, MIP-1β, TNF-α and E-selectin (all P < 0.05). The aqueous cytokine levels showed different correlations with these clinical factors; the number of previous intraocular surgeries was associated with all cytokines except MIP-1α. The AqH protein concentration and the status of intraocular lens showed similar patterns of elevation of IL-1α, IL-4, IL-6, IL-8, IL-10, IL-13, IL-17A, MIP-1β, MCP-1, E-selectin, P-selectin and sICAM-1. In conclusion, elevation of AqH cytokine levels was associated with reduced ECDs. AqH cytokine levels showed significant correlations with clinical factors associated with low ECDs.
Collapse
Affiliation(s)
- Yukari Yagi-Yaguchi
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan.
| | - Kazunari Higa
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Terumasa Suzuki
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Naohiko Aketa
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Murat Dogru
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Yoshiyuki Satake
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| |
Collapse
|
19
|
Mohamed A, Chaurasia S, Garg P. Outcome of transplanted donor corneas with more than 6 h of death-to-preservation time. Indian J Ophthalmol 2017; 64:635-638. [PMID: 27853009 PMCID: PMC5151151 DOI: 10.4103/0301-4738.194338] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Purpose: In tropical countries, physicians are skeptic in using corneas with death-to-preservation time (DTPT) >6 h, concerns being endothelial cell viability and microbial contamination on prolonged DTPT. The objective of the study was to investigate these concerns by analyzing the outcomes of corneal transplants performed using donor corneas with DTPT >6 h. Materials and Methods: The study was a retrospective case series of 65 transplants performed in 2013 with donor corneas that had DTPT >6 h (range, 6.1–9.8 h). The information on donor cornea tissues and the recipient details were collected from the eye bank and the medical records department of our tertiary eye care center. The main outcome measures were slit lamp assessment of the donor corneas, primary graft failure, graft survival, and postoperative adverse reactions, especially infections, if any. Results: Median DTPT was 7 h. Forty-four (67.7%) corneas were evaluated as optical grade and 21 (32.3%) were deemed as therapeutic grade; 36 (55.4%) were used for optical indications. There was no relationship between DTPT and the tissue grading of corneas or endothelial cell density. Of the 23 keratoplasties for purely optical indications with a minimum follow-up of 3 months, 15 (65.2%) remained clear whereas 7 (30.4%) failed (mean follow-up 15.1 ± 6.7 months). The causes of failure were primary graft failure (n = 1) and secondary graft failure (n = 6). Conclusion : The donor corneas with DTPT 6 h to 10 h can be utilized for optical indications provided that they meet the criteria of tissue acceptance for optical use.
Collapse
Affiliation(s)
- Ashik Mohamed
- Ophthalmic Biophysics, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sunita Chaurasia
- Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Prashant Garg
- Cornea and Anterior Segment Services, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| |
Collapse
|
20
|
Lekhanont K, Vanikieti K, Nimvorapun N, Chuckpaiwong V. Outcomes of descemet stripping automated endothelial keratoplasty using imported donor corneas. BMC Ophthalmol 2017; 17:41. [PMID: 28381247 PMCID: PMC5382393 DOI: 10.1186/s12886-017-0436-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/31/2017] [Indexed: 01/27/2023] Open
Abstract
Background The lack of development of local donor tissue acquisition in several regions of the world has resulted in the necessity of performing keratoplasty with imported donor corneas. The greatest concern about the use of donor corneas supplied by foreign eye banks is the effect of the increased donor death-to-operation time which inevitably occurs during the tissue recovery, tissue processing, and tissue transfer between the countries. The purpose of this study was to report the outcomes of descemet stripping automated endothelial keratoplasty (DSAEK) using imported donor corneas. Methods This retrospective, non-comparative case series investigated the outcomes of the 102 consecutive DSAEK procedures using imported donor corneas performed at a single university-based hospital between August 2006–2014. The main outcome measures were postoperative best-corrected visual acuity (BCVA), endothelial cell density (ECD), and complications. Results The mean death-to-operation time was 9.52 ± 1.48 days (range, 8–13). The mean preoperative ECD was 2761 ± 285 cells/mm2. Fuchs’ endothelial dystrophy was the predominant indication for grafting. The mean follow-up duration was 65.3 months. Ninety-three eyes had improved vision postoperatively (91.18%). BCVA unchanged in 3 eyes due to preexisting macular scar and advanced glaucoma. Primary graft failure occurred in 6 eyes (5.88%). Of the 93 eyes with improved BCVA, 100% had their best corrected vision within the first 1 year. The mean ECD at 6, 12, 24, 36, and 60 months after surgery was 1762 ± 294 cells/mm2, 1681 ± 284 cells/mm2, 1579 ± 209 cells/mm2, 1389 ± 273 cells/mm2, and 1251 ± 264 cells/mm2 respectively. The mean ECD loss at 6 months, 1 year, 2 years, 3 years, and 5 years after surgery was 36.2%, 39.1%, 42.8%, 49.7%, and 54.7% respectively. The most common complication was graft detachment/dislocation (10.78%). There were no cases of any postoperative infection. Conclusions DSAEK with imported donor corneas provides rapid and good visual rehabilitation. The percentages of endothelial cell loss were comparable to those achieved in Western series using domestic corneas in which fresher tissues were available for transplantation.
Collapse
Affiliation(s)
- Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajathevi, Bangkok, 10400, Thailand.
| | - Kavin Vanikieti
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajathevi, Bangkok, 10400, Thailand
| | - Nutthida Nimvorapun
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajathevi, Bangkok, 10400, Thailand
| | - Varintorn Chuckpaiwong
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Rama VI Rd., Rajathevi, Bangkok, 10400, Thailand
| |
Collapse
|
21
|
Ishii N, Yamaguchi T, Yazu H, Satake Y, Yoshida A, Shimazaki J. Factors associated with graft survival and endothelial cell density after Descemet's stripping automated endothelial keratoplasty. Sci Rep 2016; 6:25276. [PMID: 27121659 PMCID: PMC4848492 DOI: 10.1038/srep25276] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/14/2016] [Indexed: 01/27/2023] Open
Abstract
Postoperative endothelial cell loss leads to graft failure after corneal transplantation, and is one of the important issues for long-term prognosis. The objective of this study was to identify clinical factors affecting graft survival and postoperative endothelial cell density (ECD) after Descemet’s stripping automated endothelial keratoplasty (DSAEK). A total of 198 consecutive Japanese patients (225 eyes) who underwent DSAEK were analysed using Cox proportional hazard regression and multiple linear regression models. The candidate factors included recipient age; gender; diagnosis; pre-existing iris damage state, scored based on its severity; the number of previous intraocular surgeries; graft ECD; graft diameter; simultaneous cataract surgery; surgeons experience; intraoperative iris damage; postoperative rebubbling; and graft rejection. Eyes with higher pre-existing iris damage score and more number of previous intraocular surgery had a significantly higher risk of graft failure (HR = 8.53; P < 0.0001, and HR = 2.66; P = 0.026, respectively). Higher pre-existing iris damage score, lower graft ECD, and smaller graft diameter were identified as significant predisposing factors for lower postoperative ECD. The results show that iris damage status before DSAEK may be clinically useful in predicting the postoperative course. Avoiding intraoperative iris damage, especially in eyes with low ECD can change the prognosis of future DSAEK.
Collapse
Affiliation(s)
- Nobuhito Ishii
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan.,Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Hiroyuki Yazu
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Yoshiyuki Satake
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| | - Akitoshi Yoshida
- Department of Ophthalmology, Asahikawa Medical University, Asahikawa, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Ichikawa General Hospital, Tokyo Dental College, Chiba, Japan
| |
Collapse
|
22
|
Wakefield MJ, Armitage WJ, Jones MNA, Kaye SB, Larkin DFP, Tole D, Prydal J. The impact of donor age and endothelial cell density on graft survival following penetrating keratoplasty. Br J Ophthalmol 2015; 100:986-989. [PMID: 26567026 DOI: 10.1136/bjophthalmol-2015-306871] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/22/2015] [Accepted: 10/13/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine if donor age and preoperative endothelial cell density (ECD) affect corneal endothelial failure following penetrating keratoplasty (PK). METHODS Preoperative and postoperative data for PKs performed in the UK between April 1999 and March 2012 were analysed. Donor age was split into three groups (0-60, 61-75 and >75 years) and donor ECD was split into three groups (≤2400, 2401-2600 and >2600 cells/mm2). Cox proportional hazards regression was used to determine whether the selected subgroups of donor age and donor ECD have an impact on endothelial failure and a systematic analysis of the interaction between donor ECD and donor age was conducted. The analysis was stratified for primary corneal diagnosis (Fuchs endothelial dystrophy (FED), pseudophakic bullous keratopathy (PBK) and other) and corrected for potentially confounding factors (human leukocyte antigen matching, donor trephine diameter, deep vascularisation, the occurrence of reversible rejection episodes and receipt of systemic antiviral medication, long-term steroids or other immunosuppressive agents). RESULTS A total of 9415 patients, from the National Health Service Blood and Transplant UK Transplant Registry, who received their first PK for visual reasons were included in this study. The overall 5-year graft survival rate due to endothelial failure was 89%. Survival rates in recipients with FED, PBK and 'all other indications' were 95%, 83% and 89%, respectively. Our analysis shows that donor ECD did not affect outcome following corneal graft within the preselected categories, irrespective of diagnosis and after allowing for any potential confounding factors. Furthermore, HRs for each level of donor ECD, relative to >2600 cells/mm2, for each combination of age group and indication, were not statistically significant. CONCLUSIONS We were unable to detect a significant effect of donor age, up to 90 years, and preoperative donor ECD, above the lower limit of 2200 cells/mm2, on endothelial failure at 5 years following PK.
Collapse
Affiliation(s)
- M J Wakefield
- Department of Ophthalmology, Leicester Royal Infirmary, Leicester, UK
| | - W J Armitage
- National Health Service Blood and Transplant, Bristol Eye Bank, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol, UK
| | - M N A Jones
- National Health Service Blood and Transplant, Bristol, UK
| | - S B Kaye
- St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | | | - D Tole
- National Health Service Blood and Transplant, Bristol, UK.,Bristol Eye Hospital, Bristol, UK
| | - J Prydal
- Department of Ophthalmology, Leicester Royal Infirmary, Leicester, UK
| | | |
Collapse
|
23
|
Impact of donor characteristics on 2-year Descemet stripping automated endothelial keratoplasty outcomes in patients with Fuchs endothelial dystrophy. Cornea 2015; 34:6-10. [PMID: 25393091 DOI: 10.1097/ico.0000000000000302] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE The aim of this study was to determine the relationship between donor tissue characteristics and surgical outcomes in patients with Fuchs endothelial dystrophy (FED) 2 years after undergoing Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS A retrospective chart review was performed identifying 70 eyes with FED that underwent DSAEK. Donor endothelial cell density (ECD), donor death to preservation time, donor storage time, donor age, and postoperative recipient ECD were evaluated. Statistical analysis was performed using univariate linear regression analysis and bidirectional elimination multiple stepwise linear regression. RESULTS Cornea donor age was a predictor of postoperative ECD at postoperative years 1 and 2 (P = 0.02, adjusted R2 = 0.07 and P = 0.002, adjusted R2 = 0.13, respectively). Donor age was also a predictor of postoperative ECD at years 1 and 2 after taking into account donor ECD, death to preservation time, and donor storage time (P = 0.02, adjusted R2 = 0.62 and P = 0.002, adjusted R2 = 0.12, respectively). Donor death to preservation time was a predictor of postoperative ECD at only postoperative year 2 (P = 0.03, adjusted R2 = 0.05). Donor storage time and donor ECD did not significantly impact postoperative ECD. CONCLUSIONS Although donor age seems to have a statistically significant impact on postoperative ECD in patients with FED undergoing DSAEK, the relationship is weak. Other donor parameters did not have a consistent or significant impact on postoperative ECD.
Collapse
|
24
|
Lass JH, Szczotka-Flynn LB, Ayala AR, Benetz BA, Gal RL, Aldave AJ, Corrigan MM, Dunn SP, McCall TL, Pramanik S, Rosenwasser GO, Ross KW, Terry MA, Verdier DD. Cornea preservation time study: methods and potential impact on the cornea donor pool in the United States. Cornea 2015; 34:601-8. [PMID: 25850706 PMCID: PMC4426012 DOI: 10.1097/ico.0000000000000417] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 01/14/2015] [Accepted: 01/28/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE The aim of this study was to describe the aims, methods, donor and recipient cohort characteristics, and potential impact of the Cornea Preservation Time Study (CPTS). METHODS The CPTS is a randomized clinical trial conducted at 40 clinical sites (70 surgeons) designed to assess the effect of donor cornea preservation time (PT) on graft survival 3 years after Descemet stripping automated endothelial keratoplasty (DSAEK). Eyes undergoing surgery for Fuchs endothelial corneal dystrophy or pseudophakic/aphakic corneal edema were randomized to receive donor corneas stored ≤7 days or 8 to 14 days. Donor and patient characteristics, tissue preparation and surgical parameters, recipient and donor corneal stroma clarity, central corneal thickness, intraocular pressure, complications, and a reading center-determined central endothelial cell density were collected. Surveys were conducted to evaluate pre-CPTS PT practices. RESULTS The 1330 CPTS donors were: 49% >60 years old, 27% diabetic, had a median eye bank-determined screening endothelial cell density of 2688 cells/mm, and 74% eye bank prepared for DSAEK. A total of 1090 recipients (1330 eyes including 240 bilateral cases) had: median age of 70 years, were 60% female, 90% white, 18% diabetic, 52% phakic, and 94% had Fuchs endothelial corneal dystrophy. Before the CPTS, 19 eye banks provided PT data on 20,852 corneas domestically placed for DSAEK in 2010 to 2011; 96% were preserved ≤7 days. Of 305 American Academy of Ophthalmology members responding to a pre-CPTS survey, 233 (76%) set their maximum PT preference at 8 days or less. CONCLUSIONS The CPTS will increase understanding of factors related to DSAEK success and, if noninferiority of longer PT is shown, will have great potential to extend the available pool of endothelial keratoplasty donors.Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01537393.
Collapse
Affiliation(s)
- Jonathan H. Lass
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH
| | - Loretta B. Szczotka-Flynn
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH
| | | | - Beth A. Benetz
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH
| | | | - Anthony J. Aldave
- Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA
| | | | | | | | | | | | | | | | | | - Writing Committee for the Cornea Preservation Time Study Group
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH
- Jaeb Center for Health Research, Tampa, FL
- Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, CA
- Eye Associates Northwest, Seattle, WA
- Michigan Cornea Consultants, PC, Southfield, MI
- Cornea Associates of Texas, Dallas, TX
- Mid Atlantic Cornea Consultants, Baltimore, MD
- Central Pennsylvania Eye Center, Hershey, PA
- Midwest Eye-Banks, Ann Arbor, MI
- Devers Eye Institute, Portland, OR; and
- Verdier Eye Center, Grand Rapids, MI
| |
Collapse
|
25
|
Riddlesworth TD, Kollman C, Lass JH, Patel SV, Stulting RD, Benetz BA, Gal RL, Beck RW. A mathematical model to predict endothelial cell density following penetrating keratoplasty with selective dropout from graft failure. Invest Ophthalmol Vis Sci 2014; 55:8409-15. [PMID: 25425307 DOI: 10.1167/iovs.14-15683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE We constructed several mathematical models that predict endothelial cell density (ECD) for patients after penetrating keratoplasty (PK) for a moderate-risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). METHODS In a subset (n = 591) of Cornea Donor Study participants, postoperative ECD was determined by a central reading center. Various statistical models were considered to estimate the ECD trend longitudinally over 10 years of follow-up. A biexponential model with and without a logarithm transformation was fit using the Gauss-Newton nonlinear least squares algorithm. To account for correlated data, a log-polynomial model was fit using the restricted maximum likelihood method. A sensitivity analysis for the potential bias due to selective dropout was performed using Bayesian analysis techniques. RESULTS The three models using a logarithm transformation yield similar trends, whereas the model without the transform predicts higher ECD values. The adjustment for selective dropout turns out to be negligible. However, this is possibly due to the relatively low rate of graft failure in this cohort (19% at 10 years). Fuchs' dystrophy and pseudophakic/aphakic corneal edema (PACE) patients had similar ECD decay curves, with the PACE group having slightly higher cell densities by 10 years. CONCLUSIONS Endothelial cell loss after PK can be modeled via a log-polynomial model, which accounts for the correlated data from repeated measures on the same subject. This model is not significantly affected by the selective dropout due to graft failure. Our findings warrant further study on how this may extend to ECD following endothelial keratoplasty.
Collapse
Affiliation(s)
| | - Craig Kollman
- Jaeb Center for Health Research, Tampa, Florida, United States
| | - Jonathan H Lass
- Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio, United States
| | - Sanjay V Patel
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, United States
| | | | - Beth Ann Benetz
- Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio, United States
| | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida, United States
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida, United States
| |
Collapse
|
26
|
Feizi S. Donor cornea quality used for penetrating keratoplasty vs deep anterior lamellar keratoplasty. World J Ophthalmol 2014; 4:160-165. [DOI: 10.5318/wjo.v4.i4.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 06/06/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Deep anterior lamellar keratoplasty (DALK) has recently been introduced as an alternative procedure to penetrating keratoplasty (PK) for corneal pathologies not affecting the corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, DALK makes it possible to use donor corneas deemed unsuitable for PK. Furthermore, lamellar keratoplasty allows acellular corneal tissue to be transplanted. As a result, long-term preservation techniques are being revisited to increase the availability of donor corneas and subsequently alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in corneal transplantation techniques and hence the type of donor cornea tissues used for each technique, may require corneal surgeons and eye banks to reevaluate their selection criteria. The purpose of this systematic review is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, assess the influence of donor and eye bank factors on the quality of donor corneas, and determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.
Collapse
|
27
|
|
28
|
Abstract
PURPOSE To report the pattern and the extent of corneal endothelial cell loss immediately after a penetrating keratoplasty (PK) is performed. METHODS Ten donor corneal-scleral tissues with healthy endothelium were used to perform 10 PK surgeries on cadaver eyes. An 8.25-mm donor graft was placed into an 8.00-mm trephinated recipient bed of the cadaver eye. A 10-0 nylon suture was used with a 16-interrupted suture closure technique to secure each donor button. Viscoelastic was used to protect the endothelium in every case. The corneal donor buttons were removed and stained using trypan blue and alizarin red dyes. Digital high-definition photographs were obtained to record the pattern and quantity of stain resulting from endothelial damage and cell loss. Percent endothelial loss was calculated using the digital planimetry of our previously described Adobe Photoshop technique. RESULTS The immediate mean percent cell loss across the whole graft was 25.7% ± 7.5% (Range, 18-39). There was a distinct pattern of loss, with 58.3% of the loss in the peripheral 0.75 mm, and 12.4% of the loss in the central 3.00 mm. CONCLUSIONS The immediate total endothelial cell loss after the PK was performed was about 25%. The immediate cell loss after the PK was consistent with areas of trephination and suture placement.
Collapse
|
29
|
Lass JH, Benetz BA, Gal RL, Kollman C, Raghinaru D, Dontchev M, Mannis MJ, Holland EJ, Chow C, McCoy K, Price FW, Sugar A, Verdier DD, Beck RW. Donor age and factors related to endothelial cell loss 10 years after penetrating keratoplasty: Specular Microscopy Ancillary Study. Ophthalmology 2014; 120:2428-2435. [PMID: 24246826 DOI: 10.1016/j.ophtha.2013.08.044] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/30/2013] [Accepted: 08/30/2013] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty (PKP). DESIGN Multicenter, prospective, double-masked clinical trial. PARTICIPANTS We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥ 10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). METHODS Corneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD). MAIN OUTCOME MEASURES Endothelial cell density at 10 years. RESULTS Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm(2) (interquartile range [IQR], 522-850 cells/mm(2)), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm(2) (IQR, 483-694 cells/mm(2); P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P<0.001) and larger donor tissue size (P<0.001). Forty-two of the 176 participants (24%) had an ECD of <500 cells/mm(2) at 10 years and only 24 (14%) had an ECD of >1000 cells/mm(2). CONCLUSIONS Substantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. Greater preoperative ECD and larger donor tissue size are associated with higher ECD at 10 years.
Collapse
Affiliation(s)
- Jonathan H Lass
- Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio.
| | - Beth Ann Benetz
- Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio
| | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida
| | | | | | | | - Mark J Mannis
- University of California Davis, Sacramento, California
| | - Edward J Holland
- Department of Ophthalmology and Visual Sciences, Cincinnati Eye Institute, Cincinnati, Ohio
| | | | | | | | - Alan Sugar
- W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan
| | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
| |
Collapse
|
30
|
Abstract
PURPOSE To assess the influence of donor characteristics on the outcome of anterior lamellar keratoplasty (ALK) and to evaluate whether corneal donor tissue considered unsuitable for penetrating or posterior lamellar keratoplasty due to poor endothelial condition may be safely used for ALK. METHODS Institutional setting. One hundred sixty-six consecutive ALK (166 patients) performed for optical indication in eyes with corneal diseases not involving the corneal endothelium. The main outcome measures were graft survival, early (0-12 months postoperatively) and late (after 12 months) annual endothelial cell loss, and postoperative logarithm of the minimum angle of resolution visual acuity. RESULTS The average and extreme values of donor tissue characteristics were: donor age, 70.6 years (range, 28-88 years); organ culture time, 20.9 days (range, 12-35 days); graft endothelial cell density before transplantation, 2047 cells per millimeters (range, 100-3300 cells/mm2); and deswelling time, 2.0 days (range, 1-4 days). The average follow-up time of patients was 48.1 ± 24.8 months (mean ± SD). None of the donor characteristics significantly influenced graft survival or postoperative endothelial cell loss (early and late phase). Donor age >80 years was associated with lower postoperative visual acuity at all postoperative points in time (P < 0.05). At 3 years, the mean logarithm of the minimum angle of resolution visual acuity was 0.44 (20/55) for grafts from donors older than 80 years and 0.25 (20/35) for younger donors. This result was shown to be significant both in univariate and in multivariate analysis. CONCLUSIONS Grafts from elderly donors should be discarded before ALK. Conversely, donor tissue with poor endothelial cell density (<2000 cells/mm2) is suitable for ALK.
Collapse
|
31
|
Abstract
PURPOSE To assess corneal thickness (CT) and correlation with graft outcome after penetrating keratoplasty in the Cornea Donor Study. METHODS A total of 887 subjects with a corneal transplant for a moderate-risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) had postoperative CT measurements throughout a 5-year follow-up time. Relationships between baseline (recipient, donor, and operative) factors and CT were explored. Proportional hazards models were used to assess the association between CT and graft failure. Relationship between CT and cell density was assessed with a longitudinal repeated measures model and Spearman correlation estimates. RESULTS Higher longitudinal CT measurements were associated with the following: diagnosis of pseudophakic or aphakic corneal edema (P < 0.001), intraocular pressure >25 mm Hg during the first postoperative month (P = 0.003), white (non-Hispanic) donor race (P = 0.002), and respiratory causes of donor death (P < 0.001). Among those without graft failure within the first postoperative year, the 5-year cumulative incidence (± 95% confidence interval) of graft failure was 5% ± 5% in those with a 1-year CT ≤ 500 μm, 5% ± 3% for CT 501 to 550 μm, 7% ± 4% for CT 551 to 600 μm, and 20% ± 11% for CT >600 μm. In a multivariate analysis, both 1-year CT and cell density were associated with subsequent graft failure (P = 0.002 and 0.009). CT increase was modestly associated with endothelial cell loss during follow-up (r = -0.29). CONCLUSIONS During the first 5 years after penetrating keratoplasty, CT can serve as a predictor of graft survival. However, CT is not a substitute for cell density measurement because both measures were independently predictive of graft failure.
Collapse
|
32
|
Benetz BA, Lass JH, Gal RL, Sugar A, Menegay H, Dontchev M, Kollman C, Beck RW, Mannis MJ, Holland EJ, Gorovoy M, Hannush SB, Bokosky JE, Caudill JW. Endothelial morphometric measures to predict endothelial graft failure after penetrating keratoplasty. JAMA Ophthalmol 2013; 131:601-608. [PMID: 23493999 DOI: 10.1001/jamaophthalmol.2013.1693] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
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.
Collapse
Affiliation(s)
- Beth Ann Benetz
- Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH
| | - Jonathan H Lass
- Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH
| | | | - Alan Sugar
- W.K. Kellogg Eye Center, The University of Michigan, Ann Arbor, MI
| | - Harry Menegay
- Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH
| | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Mohamed-Noriega K, Mehta JS. Influence of donor age and post-mortem time on the metabolic profile of donor corneas and graft survival. EXPERT REVIEW OF OPHTHALMOLOGY 2012. [DOI: 10.1586/eop.12.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
34
|
Therapeutic effect of deep anterior lamellar keratoplasty for active or quiescent herpetic stromal keratitis. Graefes Arch Clin Exp Ophthalmol 2012; 250:1187-94. [PMID: 22349979 DOI: 10.1007/s00417-012-1947-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 01/04/2012] [Accepted: 01/27/2012] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To evaluate the therapeutic effect of deep anterior lamellar keratoplasty (DALK) in patients with herpetic stromal keratitis (HSK). METHODS Forty-three eyes belonging to 42 patients with HSK, including 22 eyes in the active phase and 21 eyes in the quiescent phase, underwent DALK at the Shandong Eye Institute from January 2006 to December 2009. All patients with active disease had received intravenous acyclovir and amniotic membrane implants prior to DALK. Herpes simplex virus type 1 (HSV-1) antigens from excised corneal buttons were detected by immunohistochemistry. RESULTS The follow-up ranged from 1 to 4 years (mean, 29.1 months). Graft rejection occurred in one eye (2.3%) and was reversed. Among the other 42 survived grafts (97.7%), 37 remained clear at the last visit. The best spectacle-corrected visual acuity was 20/200 or better in 95.2% of eyes and 20/40 or better in 38.1% of eyes. Six eyes (14.0%) developed recurrent HSK, one of which received a second keratoplasty due to ineffective antiviral medication. There were no significant differences in endothelial cell density between 6 months and 12 months after the surgery. By immunohistochemistry, HSV-1 antigens were observed in the stroma of 18 of 32 corneal buttons. CONCLUSIONS DALK can not only remove the corneal lesions of HSK but also reduce latent or persistent viral loads in the cornea. In eyes with active or quiescent HSK but otherwise healthy endothelia, DALK seems to be safe and promising for its favorable visual outcome, graft survival rate, and low endothelial cell loss.
Collapse
|