Donor age and factors related to endothelial cell loss 10 years after penetrating keratoplasty: Specular Microscopy Ancillary Study.
OBJECTIVE
To examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty (PKP).


METHODS
Multicenter, prospective, double-masked clinical trial.


METHODS
We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥ 10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema).


METHODS
Corneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD).


METHODS
Endothelial cell density at 10 years.


RESULTS
Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm(2) (interquartile range [IQR], 522-850 cells/mm(2)), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm(2) (IQR, 483-694 cells/mm(2); P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P<0.001) and larger donor tissue size (P<0.001). Forty-two of the 176 participants (24%) had an ECD of <500 cells/mm(2) at 10 years and only 24 (14%) had an ECD of >1000 cells/mm(2).


CONCLUSIONS
Substantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. Greater preoperative ECD and larger donor tissue size are associated with higher ECD at 10 years.
Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio. Electronic address: cds@jaeb.org.
Jonathan H
JH
Lass
Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio.
Beth Ann
BA
Benetz
Jaeb Center for Health Research, Tampa, Florida.
Robin L
RL
Gal
Jaeb Center for Health Research, Tampa, Florida.
Craig
C
Kollman
Jaeb Center for Health Research, Tampa, Florida.
Dan
D
Raghinaru
Jaeb Center for Health Research, Tampa, Florida.
Mariya
M
Dontchev
University of California Davis, Sacramento, California.
Mark J
MJ
Mannis
Department of Ophthalmology and Visual Sciences, Cincinnati Eye Institute, Cincinnati, Ohio.
Edward J
EJ
Holland
Michigan Cornea Consultants, P.C., Southfield, Michigan.
Christopher
C
Chow
Illinois Eye Bank, Chicago, Illinois.
Kristen
K
McCoy
Price Vision Group, Indianapolis, Indiana.
Francis W
FW
Price
W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan.
Alan
A
Sugar
Verdier Eye Center, Grand Rapids, Michigan.
David D
DD
Verdier
Jaeb Center for Health Research, Tampa, Florida.
Roy W
RW
Beck
D000293:Adolescent; D000328:Adult; D000368:Aged; D000375:Aging / Q000473:pathology*; D002452:Cell Count; D002648:Child; D015715:Corneal Edema / Q000503:physiopathology / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D004311:Double-Blind Method; D004728:Endothelium, Corneal / Q000473:pathology; D005125:Eye Banks; D005260:Female; D005642:Fuchs' Endothelial Dystrophy / Q000503:physiopathology / Q000601:surgery*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D055815:Young Adult