title: Endothelial morphometric measures to predict endothelial graft failure after penetrating keratoplasty.
abstract: OBJECTIVE
  Endothelial morphometric measures have potential value in predicting graft failure after penetrating keratoplasty.
  
  
  OBJECTIVE
  To determine whether preoperative and/or postoperative central morphometric measures (endothelial cell density [ECD], coefficient of variation [CV], and percentage of hexagonality [HEX]) and their postoperative changes are predictive of graft failure caused by endothelial decompensation after penetrating keratoplasty to treat a moderate-risk condition, principally Fuchs dystrophy or pseudophakic corneal edema.
  
  
  METHODS
  In a subset of Cornea Donor Study participants with graft failure, a central reading center determined preoperative and postoperative ECD, CV, and HEX from available central endothelial specular images.
  
  
  METHODS
  Cornea Image Analysis Reading Center of the Specular Microscopy Ancillary Study.
  
  
  METHODS
  Eighteen patients with graft failure due to endothelial decompensation and 54 individuals matched for most donor and recipient measures at baseline whose grafts did not fail.
  
  
  METHODS
  Change in ECD, CV, and HEX values.
  
  
  RESULTS
  Preoperative ECD was not associated with graft failure (P = .43); however, a lower ECD at 6 months was predictive of subsequent failure (P = .004). Coefficient of variation at 6 months was not associated with graft failure in univariate (P = .91) or multivariate (P = .79) analyses. We found a suggestive trend of higher graft failure with lower HEX values at 6 months (P = .02) but not at the established statistical significance (P < .01). The most recent CV or HEX values, as time-dependent variables, were not associated with graft failure (P = .26 and P = .81, respectively). Endothelial cell density values decreased during follow-up, whereas CV and HEX appear to fluctuate without an apparent trend.
  
  
  CONCLUSIONS
  Endothelial cell density at 6 months after penetrating keratoplasty is predictive of graft failure, whereas CV and HEX appear to fluctuate postoperatively, possibly indicating an unstable endothelial population in clear and failing grafts.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00006411.
authors.affiliation: Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH.
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Benetz
authors.affiliation: Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Lass
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Gal
authors.affiliation: W.K. Kellogg Eye Center, The University of Michigan, Ann Arbor, MI.
authors.forename: Alan
authors.initials: A
authors.lastname: Sugar
authors.affiliation: Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH.
authors.forename: Harry
authors.initials: H
authors.lastname: Menegay
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Mariya
authors.initials: M
authors.lastname: Dontchev
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Craig
authors.initials: C
authors.lastname: Kollman
authors.affiliation: Jaeb Center for Health Research, Tampa, FL.
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.affiliation: University of California Davis, Sacramento, CA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Mannis
authors.affiliation: Cincinnati Eye Institute, Cincinnati, OH.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Holland
authors.affiliation: Gorovoy Eye Specialists, Ft. Meyers, FL.
authors.forename: Mark
authors.initials: M
authors.lastname: Gorovoy
authors.affiliation: Sadeer Hannush, MD, Langhorne, PA.
authors.forename: Sadeer B
authors.initials: SB
authors.lastname: Hannush
authors.affiliation: Eye Care of San Diego, San Diego, CA.
authors.forename: John E
authors.initials: JE
authors.lastname: Bokosky
authors.affiliation: Charleston Eye Care, Charleston, WV.
authors.forename: James W
authors.initials: JW
authors.lastname: Caudill
mesh_terms: D000368:Aged; D002452:Cell Count; D048430:Cell Shape; D048429:Cell Size; D015715:Corneal Edema / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis*; D004728:Endothelium, Corneal / Q000473:pathology*; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery; D006084:Graft Rejection / Q000175:diagnosis*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D014019:Tissue Donors