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Corneal endothelial cell loss after nonmechanical penetrating keratoplasty depends on diagnosis: a regression analysis

  • Achim Langenbucher
  • Berthold Seitz
  • Nhung X. Nguyen
  • Gottfried O. Naumann
Clinical Investigation

Abstract

Purpose. To assess the impact of diagnosis on corneal endothelial cell loss after nonmechanical penetrating keratoplasty (PK) with regression models.

Methods. Five hundred eighty-nine eyes [273 with keratoconus (group I; PK only), 187 with Fuchs' endothelial dystrophy (group II; 77 PK only and 110 triple procedures) and 129 with bullous keratopathy (group III; 115 pseudophakic and 14 aphakic eyes)] were included in this prospective study. The time course of the endothelial cell density after PK was assessed by specular microscopy. Endothelial cell density was analyzed in cross-sectional fashion at 6 and 24 months follow-up and in longitudinal manner (follow-up 2.4±1.8 years) with linear and exponential regression models (minimizing the residuum between observed and predicted endothelial cell count). Donor age, post-mortem time, storage time and ratio of organ-cultured to short-term-preserved donor corneas did not differ significantly between groups of patients.

Results. In a cross section, endothelial cell density in group I / group II / group III decreased from 1,959±499 / 1,524±528 / 1,526±670 cells/mm2 to 1,617±553 / 1,222±520 / 1,063±384 cells/mm2 (P=0.06 / 0.04 / 0.005). Endothelial cell count was significantly higher in group I than in group II (P=0.048) and significantly higher in group II than in group III (P=0.01) at 24 months. In the linear regression model, cell count decreased in group I / group II / group III by 136±465 / 241±374 / 421±484 cells annually. In the exponential regression model, cell count decreased in group I / group II / group III by 2.9±28.0% / 11.2±21.8% / 19.3±29.4% annually. Cell loss was highly significantly lower in group I than in group II (P<0.0001) and highly significantly lower in group II than in group III (P<0.0001).

Conclusion. Endothelial cell loss seems to be least pronounced after PK in keratoconus (2.9%), followed by Fuchs' dystrophy (11.2%) and bullous keratopathy (19.3%). These differences between diagnoses indicate migration of endothelial cells along a density gradient after PK.

Keywords

Keratoconus Corneal Endothelial Cell Endothelial Cell Density Penetrate Keratoplasty Endothelial Cell Loss 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Achim Langenbucher
    • 1
  • Berthold Seitz
    • 1
  • Nhung X. Nguyen
    • 1
  • Gottfried O. Naumann
    • 1
  1. 1.Augenklinik mit Poliklinik der Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054 ErlangenGermany

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