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Impact of Donor Factors for Chronic Endothelial Cell-loss after Non-mechanical Penetrating Keratoplasty in a Regression Model
Langenbucher A., Nguyen N. X., Seitz B.,
Friedrich-Alexander-Universität, Augenklinik (Erlangen)
Purpose: To assess the diagnosis-based impact of donor parameters and trephination diameter as predictive factors on corneal endothelial cell loss after nonmechanical penetrating keratoplasty (PK) with a regression model.
Methods: 589 eyes (273 keratoconus (D1); 187 Fuchs' dystrophies (D2) and 129 pseudophakic bullous keratopathies (D3)) were included in this prospective study. The time course of the endothelial cell density (specular microscope EM 1100, TOMEY, Erlangen) after PK was assessed. Endothelial cell density was analyzed in a longitudinal manner considering at least 3 valid postoperative cell counts (follow-up 6 months to 10 years, mean 2.9±1.9 years) with a logarithmic regression model (minimizing the residuum between observed and predicted endothelial cell count). Main outcome measures included: donor age (DA), post-mortem time (PM), storage time (ST) and trephination diameter.
Results: In the logarithmic model cell count decreased in D1/D2/D3 by 2.9±28% / 11.2±22% / 19.3±29%, (D1-D2: p=0.001; D1-D3 and D2-D3: p<0.0001). In D1/D2/D3: ST (p=0.04 / p=0.05 / p=0.02) and inversely the trephination diameter (p=0.02 / p=0.04 / p=0.01) correlated with the cell loss, but not PM (p=0.16 / p=0.08 / p=0.25) and not DA (p=0.4 / p=0.12 / p=0.16).
Conclusions: A long storage of the corneoscleral button and a small trephination diameter may enhance the endothelial cell loss after penetrating keratoplasty. In contrast donor age and post-mortem time do not seem to have a significant impact.