Impact of Donor, Host, and Surgical Parameters on High Endothelial Cell Density More Than 5 Years after Penetrating Keratoplasty

Abstract

Objectives To investigate the correlation between postoperative endothelial cell loss (ECL) and donor, host, and surgical parameters, and to assess the clinical impact of maintaining a high endothelial cell density (ECD) of ≥ 1500 cells/mm² 5 years after penetrating keratoplasty (PKP).

Methods This retrospective cohort study included 216 eyes with 5 years of follow-up, of which 94 had annual visits, and who underwent normal-risk elective PKP for noninfectious indications by one corneal microsurgeon (B. S.) between 2009 and 2016.

Results Among the 216 eyes, ECL (39.1%) over 5 years postoperative exhibited weak positive correlations with storage solution time (p = 0.024) and postmortem time (p = 0.028), and moderately positively correlations with the preoperative ECD (p < 0.001). The 5-year postoperative ECL differed significantly between in domo-prepared (36.8%) and ex domo donor corneas (46.3%; p = 0.001). In the 94 eyes, no significant differences were found between the two groups for central pupil pachymetry (CCT) and BCVA (p > 0.074). However, CCT increased significantly between 1 and 4 years (p = 0.034) and 1 and 5 years postoperatively (p = 0.012), respectively. BCVA improved significantly at 1 year postoperatively and continued to improve until 2 years postoperatively (p < 0.001).

Conclusion The Lions corneal bank Saar-Lor-Lux achieved a significantly reduced ECL (36.8%) over 5 years compared to ex domo donor corneas (46.3%). A weak positive correlation was found between ECL with the storage solution time and the postmortem time, as well as a moderate positive correlation with the preoperative ECD. Although CCT increased significantly over 5 years, BCVA improved significantly from the first to the second postoperative year and remained stable thereafter.

Zusammenfassung

Zielsetzung Untersuchung der Korrelation zwischen postoperativem Endothelzellverlust (ECL) und Spender-, Empfänger- und chirurgischen Parametern sowie Bewertung der klinischen Auswirkungen der Erhaltung einer hohen Endothelzelldichte (ECD) von ≥ 1500 Zellen/mm² 5 Jahre nach penetrierender Keratoplastik (PKP).

Methoden Diese retrospektive Kohortenstudie umfasste 216 Augen mit einer Nachbeobachtungszeit von 5 Jahren, von denen 94 jährliche Visiten hatten, die zwischen 2009 und 2016 von einem Hornhautmikrochirurgen (B. S.) einer elektiven PKP mit normalem Risiko für nicht-infektiöse Indikationen unterzogen wurden.

Ergebnisse Unter den 216 Augen korrelierte die ECL (39,1%) über 5 Jahre postoperativ schwach positiv mit der Lagerungslösungszeit (p = 0,024) und mit der postmortalen Zeit (p = 0,028) sowie mäßig positiv mit der präoperativen ECD (p < 0,001). Die postoperative 5-Jahres-ECL unterschied sich signifikant zwischen in domo vorbereiteten (36,8%) und ex domo Spenderhornhäuten (46,3%; p = 0,001). Bei den 94 Augen wurden keine signifikanten Unterschiede zwischen den beiden Gruppen für die zentrale Pupillenpachymetrie (CCT) und den BCVA festgestellt (p > 0,074). Die CCT nahm jedoch zwischen 1 und 4 Jahren (p = 0,034) und 1 und 5 Jahren postoperativ (p = 0,012) signifikant zu. Der Visus verbesserte sich 1 Jahr postoperativ signifikant und verbesserte sich bis 2 Jahre postoperativ weiter (p < 0,001).

Schlussfolgerung Die Lions-Hornhautbank Saar-Lor-Lux erzielte eine signifikant geringere ECL (36,8%) über 5 Jahre im Vergleich zu Ex-Domo-Spenderhornhäuten (46,3%). Es wurde eine schwache positive Korrelation zwischen der ECL und der Dauer der Aufbewahrungslösung und der Post-mortem-Zeit sowie eine moderate positive Korrelation mit der präoperativen ECD festgestellt. Obwohl die CCT über 5 Jahre signifikant anstieg, verbesserte sich der Visus vom 1. zum 2. postoperativen Jahr signifikant und blieb danach stabil.

Keywords

endothelial cell loss - endothelial cell density - penetrating keratoplasty - PKP - 5-year follow-up

Schlüsselwörter

Endothelzellverlust - Endothelzelldichte - penetrierende Keratoplastik - PKP - 5-Jahres-Follow-up

Publication History

Received: 13 January 2024

Accepted: 07 June 2024

Article published online:
14 August 2024

• References

• 1 Bourne WM, Nelson LR, Hodge DO. Continued endothelial cell loss ten years after lens implantation. Ophthalmology 1994; 101: 1014-1023
• 2 Bourne WM, Nelson LR, Hodge DO. Central corneal endothelial cell changes over a ten-year period. Invest Ophthalmol Vis Sci 1997; 38: 779-782
• 3 Bourne WM, Hodge DO, Nelson LR. Corneal endothelium five years after transplantation. Am J Ophthalmol 1994; 118: 185-196
• 4 Pluzsik MT, Seitz B, Flockerzi FA. et al. Changing Trends in Penetrating Keratoplasty Indications between 2011 and 2018 – Histopathology of 2123 Corneal Buttons in a Single Center in Germany. Curr Eye Res 2020; 45: 1199-1204
• 5 Lass JH, Sugar A, Benetz BA. et al. Endothelial cell density to predict endothelial graft failure after penetrating keratoplasty. Arch Ophthalmol 2010; 128: 63-69
• 6 Edelhauser HF. The balance between corneal transparency and edema: the Proctor Lecture. Invest Ophthalmol Vis Sci 2006; 47: 1754-1767
• 7 [Anonymous] Corneal endothelial photography. American Academy of Ophthalmology. Ophthalmology 1991; 98: 1464-1468
• 8 Langenbucher A, Seitz B, Nguyen NX. et al. Corneal endothelial cell loss after nonmechanical penetrating keratoplasty depends on diagnosis: a regression analysis. Graefes Arch Clin Exp Ophthalmol 2002; 240: 387-392
• 9 Hoffmann F. [Suture technique for perforating keratoplasty (authorʼs transl)]. Klin Monbl Augenheilkd 1976; 169: 584-590
• 10 Suffo S, Seitz B, Daas L. The Homburg Cross-Stitch Marker for Double-Running Sutures in Penetrating Keratoplasty. Klin Monbl Augenheilkd 2021; 238: 808-814
• 11 Suffo S, el Halabi M, Seitz B. et al. Penetrating Excimer Laser Keratoplasty with vs. without the Homburg Cross-Stitch Marker in Inexperienced Surgeons. Clin Ophthalmol 2021; 15: 4607-4614
• 12 El-Husseiny M, Seitz B, Langenbucher A. et al. Excimer versus Femtosecond Laser Assisted Penetrating Keratoplasty in Keratoconus and Fuchs Dystrophy: Intraoperative Pitfalls. J Ophthalmol 2015; 2015: 645830
• 13 Seitz B, Langenbucher A, Kus MM. et al. Nonmechanical corneal trephination with the excimer laser improves outcome after penetrating keratoplasty. Ophthalmology 1999; 106: 1156-1164
• 14 Wykrota AA, Weinstein I, Hamon L. et al. Approval rates for corneal donation and the origin of donor tissue for transplantation at a university-based tertiary referral center with corneal subspecialization hosting a LIONS Eye Bank. BMC Ophthalmol 2022; 22: 17
• 15 Armitage WJ, Dick AD, Bourne WM. Predicting endothelial cell loss and long-term corneal graft survival. Invest Ophthalmol Vis Sci 2003; 44: 3326-3331
• 16 Böhringer D, Böhringer S, Poxleitner K. et al. Long-term graft survival in penetrating keratoplasty: the biexponential model of chronic endothelial cell loss revisited. Cornea 2010; 29: 1113-1117
• 17 Mannis MJ, Holland EJ, Gal RL. et al. The effect of donor age on penetrating keratoplasty for endothelial disease: graft survival after 10 years in the Cornea Donor Study. Ophthalmology 2013; 120: 2419-2427
• 18 Sugar A, Gal RL, Kollman C. et al. Factors associated with corneal graft survival in the cornea donor study. JAMA Ophthalmol 2015; 133: 246-254
• 19 Lass JH, Benetz BA, Gal RL. et al. Donor age and factors related to endothelial cell loss 10 years after penetrating keratoplasty: specular microscopy ancillary study. Ophthalmology 2013; 120: 2428-2435
• 20 Seitz B, Langenbucher A, Nguyen NX. et al. Graft endothelium and thickness after penetrating keratoplasty, comparing mechanical and excimer laser trephination: a prospective randomised study. Graefes Arch Clin Exp Ophthalmol 2001; 239: 12-17
• 21 Brand J, Langenbucher A, Zemova E. et al. 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
• 22 Armitage WJ, Jones MNA, Zambrano I. et al. The suitability of corneas stored by organ culture for penetrating keratoplasty and influence of donor and recipient factors on 5-year graft survival. Invest Ophthalmol Vis Sci 2014; 55: 784-791
• 23 Chung SH, Kim HK, Kim MS. Corneal endothelial cell loss after penetrating keratoplasty in relation to preoperative recipient endothelial cell density. Ophthalmologica 2010; 224: 194-198
• 24 Ghareeb AE, Figueiredo MS, Pradhan SP. et al. Long-Term Graft Survival and Decline in Endothelial Cell Density Following Penetrating Keratoplasty with Organ-Cultured Corneas. Ophthalmol Ther 2022; 11: 1131-1146
• 25 Schönit S, Maamri A, Zemova E. et al. Prevalence and Impact of Cornea Guttata in the Graft After Penetrating Keratoplasty in Germany. Cornea 2022; 41: 1495-1502
• 26 Verdier DD, Sugar A, Baratz K. et al. Corneal thickness as a predictor of corneal transplant outcome. Cornea 2013; 32: 729-736
• 27 Borderie VM, Touzeau O, Bourcier T. et al. Outcome of graft central thickness after penetrating keratoplasty. Ophthalmology 2005; 112: 626-633
• 28 Borderie VM, Boëlle PY, Touzeau O. et al. Predicted long-term outcome of corneal transplantation. Ophthalmology 2009; 116: 2354-2360
• 29 Williams KA, Lowe M, Bartlett C. et al. Risk factors for human corneal graft failure within the Australian corneal graft registry. Transplantation 2008; 86: 1720-1724
• 30 Flockerzi E, Xanthopoulou K, Goebels SC. et al. Keratoconus staging by decades: a baseline ABCD classification of 1000 patients in the Homburg Keratoconus Center. Br J Ophthalmol 2021; 105: 1069-1075
• 31 Hamon L, Daas L, Mäurer S. et al. Thickness and Curvature Changes of Human Corneal Grafts in Dextran-Containing Organ Culture Medium Before Keratoplasty. Cornea 2021; 40: 733-740