Endothelial Cell Loss: Donor, Recipient, and Operative Factors
JAMA Ophthalmology, February 2019
For the Cornea Preservation Time Study (CPTS), researchers looked at the effect of donor preservation time (PT) on graft survival and endothelial cell loss after Descemet stripping automated endothelial keratoplasty (DSAEK). Results showed a small difference in endothelial cell loss at 3 years. In a secondary analysis of data from this prospective trial, Lass et al. found that donor diabetes, recipient diagnosis of pseudophakic/aphakic corneal edema (PACE), lower screening endothelial cell density, and operative complications were associated with lower endothelial cell density three years after DSAEK, potentially affecting long-term graft success.
In CPTS, 1,330 eyes (1,090 participants; median age, 70 years) underwent DSAEK for Fuchs dystrophy or PACE. Of these, 913 eyes (749 patients) with a functioning graft and analyzable preoperative and endothelial images at the three-year mark were included in the secondary analysis. Preoperative endothelial cell density was used as the baseline. Recipient and donor characteristics were similar to those of the full CPTS population.
In the final multivariable model, the following factors were associated with lower endothelial cell density at three years: donors with diabetes (‒103 cells/mm2), lower screening endothelial cell density (‒234 per 500 cells/mm2), PACE diagnosis (‒257 cells/mm2), and operative complications (‒324 cells/mm2). Mean endothelial cell loss from baseline to year 3 was 47% in participants with tissue from donors with diabetes versus 43% without; 53% in recipients with PACE versus 44% with Fuchs dystrophy; and 55% with surgical complications versus 44% without.
Among the factors linked to lower endothelial cell density in this study, surgical complications are the most modifiable.
The authors urged additional study of the effects of diabetes on long-term DSAEK outcome, coupled with improved characterization of diabetes in donors and recipients by means of multiple methodologies. Although findings of this study do not prove causation, they may help to optimize donor selection, minimize surgical trauma, and improve outcomes.
The original article can be found here.