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

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