title: In Vivo Characteristics of Corneal Endothelium/Descemet Membrane Complex for the Diagnosis of Corneal Graft Rejection.
abstract: OBJECTIVE
  To evaluate the utility of endothelial/Descemet membrane complex (En/DM) characteristics in diagnosing corneal graft rejection.
  
  
  METHODS
  Diagnostic reliability study.
  
  
  METHODS
  One hundred thirty-nine eyes (96 corneal grafts post penetrating keratoplasty or Descemet stripping automated endothelial keratoplasty: 40 clear, 23 actively rejecting, 24 rejected, and 9 nonimmunologic failed grafts; along with 43 age-matched control eyes) were imaged using high-definition optical coherence tomography. Images were used to describe En/DM and measure central corneal thickness (CCT) and central En/DM thickness (DMT). En/DM rejection index (DRI) was computed to detect the relative En/DM thickening to the entire cornea.
  
  
  RESULTS
  In actively rejecting grafts, DMT and DRI were significantly greater than controls and clear grafts (28, 17, and 17 μm and 1.5, 1 and 1, respectively; P < .001). Rejected grafts had the highest DMT and DRI compared to all groups (59 μm and 2.1; P < .001). DMT and DRI showed excellent accuracy, significantly better than that of CCT, in differentiating actively rejecting from clear grafts (100% and 96% sensitivity; 92.5% and 92.5% specificity), actively rejecting from rejected grafts (88% and 83% sensitivity; 91% and 83% specificity), and nonimmunologic failed from rejected grafts (100% and 100% sensitivity; 88% and 100% specificity). DMT correlated significantly with rejection severity (P < .001).
  
  
  CONCLUSIONS
  In corneal grafts, in vivo relative thickening of the En/DM is diagnostic of graft rejection as measured by DMT and DRI. These indices have excellent accuracy, sensitivity, and specificity in detecting graft immunologic status, superior to CCT. DMT is a quantitative index that correlates accurately with the severity of rejection.
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida; Saint Louis University Eye Institute, St Louis, Missouri; Department of Ophthalmology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. Electronic address: m.aboushousha@med.miami.edu.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abou Shousha
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: Sonia H
authors.initials: SH
authors.lastname: Yoo
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Sayed
authors.affiliation: Saint Louis University Eye Institute, St Louis, Missouri.
authors.forename: Sean
authors.initials: S
authors.lastname: Edelstein
authors.affiliation: Saint Louis University Eye Institute, St Louis, Missouri.
authors.forename: Matthew
authors.initials: M
authors.lastname: Council
authors.affiliation: Saint Louis University Eye Institute, St Louis, Missouri.
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Shah
authors.affiliation: Saint Louis University Eye Institute, St Louis, Missouri.
authors.forename: Joshua
authors.initials: J
authors.lastname: Abernathy
authors.affiliation: Saint Louis University Eye Institute, St Louis, Missouri.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Schmitz
authors.affiliation: Saint Louis University Eye Institute, St Louis, Missouri.
authors.forename: Patrick
authors.initials: P
authors.lastname: Stuart
authors.affiliation: Saint Louis University Eye Institute, St Louis, Missouri.
authors.forename: Rocio
authors.initials: R
authors.lastname: Bentivegna
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: Maria P
authors.initials: MP
authors.lastname: Fernandez
authors.affiliation: Saint Louis University Eye Institute, St Louis, Missouri.
authors.forename: Christopher
authors.initials: C
authors.lastname: Smith
authors.affiliation: Saint Louis University Eye Institute, St Louis, Missouri.
authors.forename: Xiaotang
authors.initials: X
authors.lastname: Yin
authors.affiliation: Departments of Ophthalmology & Visual Sciences and Pathology & Immunology, Washington University, St Louis, Missouri.
authors.forename: George J
authors.initials: GJ
authors.lastname: Harocopos
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: Sander R
authors.initials: SR
authors.lastname: Dubovy
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: William J
authors.initials: WJ
authors.lastname: Feuer
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: Jianhua
authors.initials: J
authors.lastname: Wang
authors.affiliation: Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, Florida.
authors.forename: Victor L
authors.initials: VL
authors.lastname: Perez
mesh_terms: D000368:Aged; D003316:Corneal Diseases / Q000175:diagnosis / Q000601:surgery*; D003886:Descemet Membrane / Q000473:pathology* / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D004728:Endothelium, Corneal / Q000473:pathology* / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence / Q000379:methods*; D014792:Visual Acuity