title: Endothelial cell density to predict endothelial graft failure after penetrating keratoplasty.
abstract: OBJECTIVE
  To determine whether preoperative and/or postoperative central endothelial cell density (ECD) and its rate of decline postoperatively are predictive of graft failure caused by endothelial decompensation following penetrating keratoplasty to treat a moderate-risk condition, principally, Fuchs dystrophy or pseudophakic corneal edema.
  
  
  METHODS
  In a subset of Cornea Donor Study participants, a central reading center determined preoperative and postoperative ECD from available specular images for 17 grafts that failed because of endothelial decompensation and 483 grafts that did not fail.
  
  
  RESULTS
  Preoperative ECD was not predictive of graft failure caused by endothelial decompensation (P = .91). However, the 6-month ECD was predictive of subsequent failure (P < .001). Among those that had not failed within the first 6 months, the 5-year cumulative incidence (+/-95% confidence interval) of failure was 13% (+/-12%) for the 33 participants with a 6-month ECD of less than 1700 cells/mm(2) vs 2% (+/-3%) for the 137 participants with a 6-month ECD of 2500 cells/mm(2) or higher. After 5 years' follow-up, 40 of 277 participants (14%) with a clear graft had an ECD below 500 cells/mm(2).
  
  
  CONCLUSIONS
  Preoperative ECD is unrelated to graft failure from endothelial decompensation, whereas there is a strong correlation of ECD at 6 months with graft failure from endothelial decompensation. A graft can remain clear after 5 years even when the ECD is below 500 cells/mm(2).
authors.affiliation: Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio, USA. cds@jaeb.org
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Lass
authors.forename: Alan
authors.initials: A
authors.lastname: Sugar
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Benetz
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.forename: Mariya
authors.initials: M
authors.lastname: Dontchev
authors.forename: Robin L
authors.initials: RL
authors.lastname: Gal
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.forename: Robert
authors.initials: R
authors.lastname: Gross
authors.forename: Ellen
authors.initials: E
authors.lastname: Heck
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Holland
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Mannis
authors.forename: Irving
authors.initials: I
authors.lastname: Raber
authors.forename: Walter
authors.initials: W
authors.lastname: Stark
authors.forename: R Doyle
authors.initials: RD
authors.lastname: Stulting
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002452:Cell Count; D002648:Child; D015715:Corneal Edema / Q000150:complications; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000150:complications; D006084:Graft Rejection / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D057234:Preoperative Period; D014019:Tissue Donors