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Impressum
Regression analysis of corneal endothelium after nonmechanical penetrating keratoplasty
Langenbucher A., Nguyen N. X., Seitz B.
Department of Ophthalmology, University of Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen
Purpose: The purpose of this study was to assess the impact of
diagnoses and simultaneous cataract surgery on corneal endothelial cell
density with regression models after nonmechanical penetrating keratoplasty
(PK).
Patients and Methods: Six-hundred forty-nine eyes (187 primary
dystrophies (D1), 273 keratoconus (D2) and 189 others (D3); 491 PK only
(PO) and 158 TRIPLE-procedures (TR) were included in this prospective
study. The time course of the endothelial cell density (specular microscope
EM 1100, TOMEY, Erlangen) after PK was assessed. First, endothelial cell
density was analyzed in a cross sectional manner at the 6, 12, 18 and
24 months follow-up intervals and, secondly, in a longitudinal manner
(follow-up from 6 months to 10 years (2.4±1.8 years)) with linear
and logarithmic regression models in the sense of minimizing the residuum
(distance between observed and predicted endothelial cell count). Post-mortem
time (PM), storage time (ST) and donor age (DA) were considered as covariates.
Results: In a cross section, mean endothelial cell density in D1/D2/D3
decreased from 1651±512/1903±444/1589±551 cells/mm2
to 1310±515/1702±551/1209±443 cells/mm2 (p=0.005/0.02/0.01)
and in PO/TR from 1785±507/1652±514 cells/mm2 to 1524±574/1320±493
cells/mm2 (p=0.05/0.005). In the linear model, cell count decreased in
D1/D2/D3 by 222±307/71±494/338±640 cells annually
and in PO/TR by 153±537/262±574 cells annually. In the logarithmic
model, cell count decreased in D1/D2/D3 by 8.3±23%/6.5±34%/12.5±40%
annually (D1-D2: p=0.003; D1-D3: p=0.03; D2-D3: p<0.001) and in PO/TR
by 2.8±36%/10.3±35% (p=0.04). ST, but not PM and DA correlated
with the cell loss (p=0.04).
Conclusion: Endothelial cell loss seems to be least pronounced
after penetrating keratoplasty in keratoconus (6.5%) followed by primary
dystrophies (8.3%). In PK only, a significant lower cell loss may be expected
compared to PK combined with simultaneous cataract surgery during a long-term
follow-up.