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  • Factors Associated With Graft Success in the Cornea Preservation Time Study

    By Lynda Seminara
    Selected By: Stephen D. McLeod, MD
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    Journal Highlights

    Ophthalmology, November 2018

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    The Cornea Preservation Time Study (CPTS) is the largest prospective, randomized, double-masked clinical trial studying contemporary corneal transplantation. It includes prospective data for 1,330 Descemet stripping automated endothelial keratoplasty (DSAEK) procedures performed by 70 experienced surgeons. Using CPTS data, Terry et al. sought to discern whether any donor, recipient, or operative factors may predict long-term graft success and, ultimately, improve evidence-based guidelines. They found that early and later DSAEK success was greater when surgical complications did not occur and if the donor did not have diabetes.

    The 1,090 patients evaluated in the CPTS had undergone DSAEK for Fuchs endothelial corneal dystrophy (94% of eyes) or pseudophakic/aphakic corneal edema (PACE; 6% of eyes). Eyes with DSAEK were assigned randomly to receive a cornea with preservation time of 0-7 days (n = 675) or 8-14 days (n = 655). Donor, recipient, and operative parameters were documented. Graft failure was defined as any of the following: regrafting for any reason, a graft that did not become clear by 8 weeks postoperatively, or a graft that was clear initially but became cloudy and remained so for 90 days. Failure in the first 8 weeks was subclassified as primary donor failure or early failure, in the absence or presence of surgical complications, respectively. The main outcome measure was graft success at 3 years.

    Of the 1,330 grafts, 1,251 (94%) remained clear at 3 years and were deemed successful. After adjusting for preservation time, the authors noted that tissue from donors with diabetes and the oc­currence of surgical complications were linked to greater risk of primary/early graft failure. Patients with PACE were more likely than those with Fuchs dystrophy to experience graft failure by 3 years postoperatively.

    Factors with little or no influence on graft outcome included donor age, preoperative donor en­dothelial cell density, graft diameter, and use of an injector for graft insertion. Further exploration is needed to determine the specific mechanisms in diabetic donors and PACE recipients that contribute to the lower likelihood of graft success.

    The original article can be found here.