title: Corneal endothelium and postoperative outcomes 15 years after penetrating keratoplasty.
abstract: OBJECTIVE
  To determine changes in the central endothelium and thickness of grafted corneas and the cumulative probability of developing glaucoma, of graft rejection, and of graft failure 15 years after penetrating keratoplasty.
  
  
  METHODS
  Longitudinal cohort study of 500 consecutive penetrating keratoplasties by one surgeon.
  
  
  METHODS
  Regrafted eyes, fellow eyes of bilateral cases, and patients not granting research authorization were excluded, leaving 388 grafts for analysis. At intervals after surgery, we photographed the endothelium and measured corneal thickness using specular microscopy. The presence of glaucoma, graft rejection, and graft failure were recorded.
  
  
  RESULTS
  The 67 patients examined at 15 years represented 30% of the available clear grafts. Endothelial cell loss from preoperative donor levels was 71 +/- 12% (mean +/- standard deviation, n = 67), endothelial cell density was 872 +/- 348 cells/mm(2), and corneal thickness was 0.59 +/- 0.06 mm. Endothelial cell density was unchanged between 10 and 15 years, whereas corneal thickness increased (P = .001, n = 55). The mean annual rate of endothelial cell loss from 10 to 15 years after surgery was 0.2 +/- 5.7% (n = 54). The cumulative probability of developing glaucoma, graft rejection, or graft failure was 20%, 23%, and 28%, respectively, and 6 of the 8 graft failures after 10 years resulted from late endothelial failure.
  
  
  CONCLUSIONS
  From 10 to 15 years after penetrating keratoplasty, the annual rate of endothelial cell loss was similar to that of normal corneas, corneal thickness increased, and late endothelial failure was the major cause of graft failure.
authors.affiliation: Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Sanjay V
authors.initials: SV
authors.lastname: Patel
authors.forename: David O
authors.initials: DO
authors.lastname: Hodge
authors.forename: William M
authors.initials: WM
authors.lastname: Bourne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003316:Corneal Diseases / Q000601:surgery; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005901:Glaucoma / Q000175:diagnosis / Q000209:etiology*; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011336:Probability; D012307:Risk Factors