Endothelial Cell Density to Predict Endothelial Graft Failure After Penetrating Keratoplasty

Lass, Jonathan H.

doi:10.1001/archophthalmol.2010.128.63

Cited by 115 publications

(71 citation statements)

References 25 publications

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“…1 The causes of endothelial cell loss after corneal transplantation (PK or DALK) are numerous, including mechanical damage associated with the operation itself and later stage immune reactions that lead to rejection of the donor endothelial cells. An assessment of the endothelial cell density (ECD) is a commonplace method of pre-and post-operative monitoring of a corneal graft by using either specular microscopy [2][3][4][5][6][7][8] or, more recently, confocal microscopy. [9][10][11][12] Such high-resolution imaging of the corneal endothelium is generally needed to allow for endothelial cell counting and this is done, as it has long been recognised that a very low endothelial cell count may ultimately lead to reduced endothelial function and to subsequent graft failure.…”

Section: Introductionmentioning

confidence: 99%

In vivo confocal microscopy of the corneal endothelium: comparison of three morphometry methods after corneal transplantation

Jonuscheit

Doughty

Ramaesh

2011

Eye

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Purpose The purpose of this study was to assess the endothelium of corneal grafts by in vivo confocal microscopy (IVCM), and to evaluate an automated endothelial software system in comparison with a manual cell count and planimetry. Patients and methods Overall, 40 corneal grafts (20 deep anterior lamellar keratoplasties (DALKs) and 20 penetrating keratoplasties (PKs)) were assessed by scanning-slit IVCM. The endothelial cell density (ECD) was estimated with the automated and the manual cell count method of the instrument's Nidek Advanced Vision Information System (NAVIS) software. The results were compared with planimetry as the reference method, and the agreement was assessed. Results The mean ( ± SD) automated ECD was 2278 ± 524 cells/mm 2 (range 1167-3192 cells/mm 2 ), whereas the manual cell count method gave significantly lower ECDs with a mean of 1213±677 cells/mm 2 (range 218-2440 cells/mm 2 ; Po0.001). The manual cell counts were also significantly lower than those by planimetry, with a mean ECD of 1617 ± 813 cells/mm 2 (range 336-2941, Po0.001). Bland-Altman analyses indicated that the limits of agreement (LoA) between the automated and the planimetry method were À671 and þ 1992 cells/mm 2 , whereas they were À1000 and þ 202 cells/mm 2 when comparing the manual cell counts with planimetry. Conclusion Following keratoplasty, the NAVIS automated method is likely to overestimate endothelial cell counts due to oversegmenting of the cell domains. Automated ECDs are substantially higher than those by the manual counting method or planimetry. The differences are considerably larger post-keratoplasty than for normal corneas, and the methods should not be used interchangeably.

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Section: Introductionmentioning

confidence: 99%

In vivo confocal microscopy of the corneal endothelium: comparison of three morphometry methods after corneal transplantation

Jonuscheit

Doughty

Ramaesh

2011

Eye

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“…Despite contradictory results of studies evaluating the effect of donor and eye-bank variables on postoperative ECD and morphology, the majority of studies showed that donor preservation method and time, donor age, cause of death, and preoperative donor ECD and/or morphometric measures (coefficient of variation and hexagonality) had no influence on overall graft failure [12,14,26,[38][39][40][41]. However, one study reported that preoperative risk factors for developing late endothelial failure included low ECD and older donor age [16].…”

Section: Effect Of Donor and Eye-bank Variables On Clinical Outcomesmentioning

confidence: 99%

Donor Graft Quality Used for Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty

Feizi¹

2016

Advances in Eye Surgery

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Deep anterior lamellar keratoplasty (DALK) has been recently introduced as an alternative to penetrating keratoplasty (PK) for corneal pathologies not involving corneal endothelium. DALK does not rely on donor endothelium and requires less rigid criteria for donor corneal tissue quality. Therefore, it provides a greater availability of donor corneas that do not need perfectly healthy endothelium and high endothelial cell density to be suitable for PK. Furthermore, as lamellar corneal surgery expands the potential use of acellular corneal tissue, long-term preservation techniques are being revisited as a way to increase availability of corneal tissue to alleviate constraints of availability, cost, storage, and transportation in many countries. The recent alterations in the technique of corneal transplantation and hence the type of donor cornea tissues used for each technique, may require eye banks and corneal surgeons to reassess their selection criteria but it is important for any changes to be evidence-based. The purpose of this chapter, therefore, is to present an updated analysis on the type and quality of donor corneas used for PK and DALK, to evaluate the impact of donor and eye bank variables on the suitability of corneas for transplantation and then go on to determine whether any of these donor factors affect clinical outcomes, complications, and graft survivals.

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“…1 The interplay and importance of cell density, polymegathism, and pleomorphism are areas of active research as researchers look for markers of endothelial health. In a recent article by the Cornea Donor Study Investigators Group, 38 donor cornea preoperative cell density is unrelated to rates of graft failure. Even grafts with 500 cells/mm 2 could maintain clarity (although most grafts with a low cell count do fail).…”

Section: Measurement Of the Endotheliummentioning

confidence: 99%

“…Even grafts with 500 cells/mm 2 could maintain clarity (although most grafts with a low cell count do fail). 38 Ex vivo examination of specimens from older human corneas exhibit reduced protein expression and higher levels of oxidative DNA damage. 39,40 Evaluation of the peripheral endothelial cell counts would be a useful adjunct in clinical trials because of the higher ECD in the periphery.…”

Section: Measurement Of the Endotheliummentioning

confidence: 99%

Corneal endothelium after refractive surgery

Woodward¹,

Edelhauser²

2011

Journal of Cataract and Refractive Surgery

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Endothelial Cell Density to Predict Endothelial Graft Failure After Penetrating Keratoplasty

Cited by 115 publications

References 25 publications

In vivo confocal microscopy of the corneal endothelium: comparison of three morphometry methods after corneal transplantation

In vivo confocal microscopy of the corneal endothelium: comparison of three morphometry methods after corneal transplantation

Donor Graft Quality Used for Penetrating Keratoplasty and Deep Anterior Lamellar Keratoplasty

Corneal endothelium after refractive surgery

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