Elsevier

Ophthalmology

Volume 115, Issue 4, April 2008, Pages 627-632.e8
Ophthalmology

Original article
Donor Age and Corneal Endothelial Cell Loss 5 Years after Successful Corneal Transplantation: Specular Microscopy Ancillary Study Results

https://doi.org/10.1016/j.ophtha.2008.01.004Get rights and content

Objective

To determine whether endothelial cell loss 5 years after successful corneal transplantation is related to the age of the donor.

Design

Multicenter, prospective, double-masked clinical trial.

Participants

Three hundred forty-seven subjects participating in the Cornea Donor Study who had not experienced graft failure 5 years after corneal transplantation for a moderate-risk condition (principally Fuchs’ dystrophy or pseudophakic corneal edema).

Testing

Specular microscopic images of donor corneas obtained before surgery and postoperatively at 6 months, 12 months, and then annually through 5 years were submitted to a central reading center to measure endothelial cell density (ECD).

Main Outcome Measure

Endothelial cell density at 5 years.

Results

At 5 years, there was a substantial decrease in ECD from baseline for all donor ages. Subjects who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 69% in the study eye, resulting in a 5-year median ECD of 824 cells/mm2 (interquartile range, 613–1342), whereas subjects who received a cornea from a donor 66 to 75 years old experienced a cell loss of 75%, resulting in a median 5-year ECD of 654 cells/mm2 (interquartile range, 538–986) (P [adjusted for baseline ECD] = 0.04). Statistically, there was a weak negative association between ECD and donor age analyzed as a continuous variable (r [adjusted for baseline ECD] = −0.19; 95% confidence interval, −0.29 to −0.08).

Conclusions

Endothelial cell loss is substantial in the 5 years after corneal transplantation. There is a slight association between cell loss and donor age. This finding emphasizes the importance of longer-term follow-up of this cohort to determine if this relationship affects graft survival.

Section snippets

Materials and Methods

Details of the CDS protocol have been reported,10, 11 and pertinent aspects are briefly described here. The protocol was approved by institutional review boards at each investigational site, and each subject gave written informed consent to participate in the study. Eligible subjects were between 40 and 80 years old and had a corneal disease associated with endothelial dysfunction and moderate risk of failure (principally Fuchs’ dystrophy and pseudophakic corneal edema). Eligible corneas were

Results

Mean age at the time of transplantation of the 347 subjects included in the analysis was 69 years; 224 (65%) of the subjects were female, and 333 (96%) were Caucasian, 9 (3%) African American, 2 (<1%) Hispanic, and 3 (<1%) other race. Indications for corneal transplantation included Fuchs’ dystrophy in 264 (76%), pseudophakic/aphakic corneal edema in 72 (21%), and a variety of other causes in 11 (3%). One hundred twenty-six eyes (36%) were pseudophakic and 16 (5%) aphakic at the time of

Discussion

The SMAS was developed to measure corneal ECD changes over time in the CDS population. The ECD declines with age in the normal cornea. This process of cell loss is greatly accelerated after penetrating keratoplasty and persists for years after transplantation.7 Thus, chronic endothelial cell loss after penetrating keratoplasty is a recognized phenomenon that can impact graft survival.

In this study, we found that endothelial cell loss among successful transplants was substantial during the first

References (16)

There are more references available in the full text version of this article.

Cited by (0)

Manuscript no. 2007-1567.

Supported by the National Eye Institute, Bethesda, Maryland (cooperative agreement nos. EY12728, EY12358). Additional support provided by Eye Bank Association of America, Washington, DC; Bausch & Lomb, Inc., Rochester, New York; Tissue Banks International, Baltimore, Maryland; Vision Share, Inc., Apex, North Carolina; San Diego Eye Bank, San Diego, California; Cornea Society, Fairfax, Virginia; Katena Products, Inc., Denville, New Jersey; ViroMed Laboratories, Inc., Minnetonka, Minnesota; Midwest Eye-Banks (Michigan Eye-Bank, Illinois Eye-Bank), Ann Arbor, Michigan; Konan Medical Corp., Torrance, California; Eye Bank for Sight Restoration, New York, New York; SightLife, Seattle, Washington; Sight Society of Northeastern New York (Lions Eye Bank of Albany), Albany, New York; and Lions Eye Bank of Oregon, Portland, Oregon.

E-mail: [email protected].

See “Appendix 2” (available at http://aaojournal.org) for a list of Group members.

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