Donor age and corneal endothelial cell loss 5 years after successful corneal transplantation. Specular microscopy ancillary study results.
OBJECTIVE
To determine whether endothelial cell loss 5 years after successful corneal transplantation is related to the age of the donor.


METHODS
Multicenter, prospective, double-masked clinical trial.


METHODS
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).


METHODS
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).


METHODS
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/mm(2) (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/mm(2) (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.
Cornea Donor Study Coordinating Center, Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647, USA. cds@jaeb.org
Lass
Jonathan H
JH
Gal
Robin L
RL
Dontchev
Mariya
M
Beck
Roy W
RW
Kollman
Craig
C
Dunn
Steven P
SP
Heck
Ellen
E
Holland
Edward J
EJ
Mannis
Mark J
MJ
Montoya
Monty M
MM
Schultze
Robert L
RL
Stulting
R Doyle
RD
Sugar
Alan
A
Sugar
Joel
J
Tennant
Bradley
B
Verdier
David D
DD
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D002648:Child; D015715:Corneal Edema / Q000209:etiology / Q000601:surgery*; D016039:Corneal Transplantation; D004311:Double-Blind Method; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D019591:Pseudophakia / Q000150:complications; D014019:Tissue Donors