Corneal endothelial cell density and morphology in ophthalmologically healthy young individuals in Japan: An observational study of 16842 eyes.

We aimed to investigate the cell density and morphology of the corneal endothelium in ophthalmologically healthy young Japanese, given the lack of normative data in literature. This observational study included eyes without ophthalmologic diseases, besides refractive errors, examined between 1996 and 2015 at Miyata Eye Hospital. Eyes with a history of ophthalmologic diseases or contact lens usage were excluded. Correlation of corneal endothelial cell density (ECD), coefficient of variation (CV), appearance rate of hexagonal cells (6A), and cell area with age were examined. Multivariate linear regression analysis was performed to determine the predictors of corneal parameters. We included 16842 eyes of 8421 individuals (19.6 ± 8.7 years). ECD was 3109.0 ± 303.7 cells/mm2 and significantly reduced with age (p < 0.001). The ECD reduction rate was 0.42%/year in the total population. On multivariate analysis, age and sex were significantly correlated with ECD, CV, 6A, and cell area (all p < 0.001). ECD, 6A, CV, and cell area are significantly associated with age in healthy young Japanese individuals. Monitoring their corneal endothelium is essential to assess the risk of endothelial damage.

Determinants of corneal endothelial cell loss after sulcus placement of Ahmed and Baerveldt drainage device surgery.

AIM: In patients who underwent multiple intraocular surgeries, we evaluated determinants of decreased corneal endothelial cell density (CECD) after sulcus placement following Ahmed and Baerveldt drainage device surgery. METHODS: We retrospectively reviewed consecutive patients with glaucoma who underwent sulcus placement with an Ahmed glaucoma valve or a Baerveldt glaucoma implant. We compared presurgical and postsurgical CECD and risk factors for decreased CECD. RESULTS: We examined 41 eyes of 41 patients. Postsurgical CECD measurements were assessed 2.0±1.0 times during a median follow-up period of 28 months. The mean intraocular pressure (IOP) decreased from 28.4±11.6 mmHg to 12.2±5.3 mmHg 24 months after the operation. At 24 months, CECD decreased 14.6±5.4% after considering the variability in the number and time points of CECD determinations. History of prior surgery and higher preoperative IOP were significantly associated with a trend for a time-dependent decrease in CECD. CONCLUSIONS: Risk factors for decreased CECD after sulcus placement during Ahmed and Baerveldt drainage device surgery included the number of previous intraocular surgeries and higher presurgical IOP.

Descemet Membrane Endothelial Keratoplasty With a Pull-Through Insertion Device: Surgical Technique, Endothelial Cell Loss, and Early Clinical Results.

PURPOSE: To describe a surgical technique for Descemet membrane endothelial keratoplasty (DMEK) using a pull-through, endothelium-in insertion device, the DMEK EndoGlide. We evaluated the endothelial cell loss (ECL) associated with the EndoGlide-DMEK (E-DMEK) technique in both ex vivo and prospective clinical studies. METHODS: The ex vivo study involved calcein acetoxymethyl staining and preparation of DMEK grafts, which were trifolded endothelium-in, loaded into the EndoGlide, pulled through, and unfolded in imaging dishes. Inverted fluorescent microscopy was performed, and ECL was quantified using trainable segmentation software. The prospective clinical series describes the outcomes of consecutive surgeries using the E-DMEK technique. Grafts were pulled through the EndoGlide with forceps and unfolded in the anterior chamber endothelium-down. Our main outcome measure was ECL in both studies. RESULTS: In the ex vivo study with 9 human donor corneas, mean ECL was 15.2% ± 5.4% (n = 9). In our clinical series of 69 eyes, leading indications for surgery were pseudophakic/aphakic bullous keratopathy (47.8%), previous failed grafts (23.2%), and Fuchs endothelial dystrophy (18.8%). Rebubbling and primary graft failure rates related to E-DMEK were 11.6% and 1.5%, respectively. Among eyes with at least 6 months of follow-up, mean preoperative endothelial cell density was 2772 (range 2457-3448) cells/mm, and postoperative endothelial cell density was 1830 (range 541-2545) cells/mm. Mean ECL was 33.6% (range 7.5-80.4; n = 32) at the 7.1 (range 6-11) months follow-up. CONCLUSIONS: The ex vivo and pilot clinical studies suggest that E-DMEK shows acceptable rates of ECL, with safe and promising early clinical outcomes.

Analyses of Factors Affecting Endothelial Cell Density in an Eye Bank Corneal Donor Database.

PURPOSE: To analyze the factors affecting central corneal endothelial cell density (ECD) in an eye bank corneal donor database. METHODS: The Lion's Eye Institute corneal donor database consisting of 18,665 donors (34,234 corneas) aged 20 years or older was analyzed. In particular, differences in the ECD based on age, sex, race, prior ocular surgery, a history of systemic diseases, and smoking were investigated. Furthermore, risk factors for donor cell count inadequacy (defined here as ECD less than 2000/mm) were identified. RESULTS: ECD decreased with age. Regarding race, the average ECD of African American donors was higher than those of white or Hispanic donors. A history of diabetes mellitus (DM) and ocular surgery were associated with a lower ECD. Donor medical history of hypertension, glaucoma, depression, dementia, Parkinson disease, hyper- or hypothyroidism, or smoking did not seem to affect the ECD. The risk factors for donor cell count inadequacy, based on binary logistic regression analyses were advanced age [65-74 years yielded an odds ratio of 17.8; confidence interval (CI), 10.6-29.8; P < 0.001; and 75-99 years yielded an odds ratio of 24.6 (CI, 14.5-41.61; P < 0.001) when compared with 20-34 years], cataract surgery (odds ratio, 4.3; CI, 4.0-4.8; P < 0.001), and DM (odds ratio, 1.2; CI, 1.1-1.3; P = 0.001). CONCLUSIONS: Age, race, ocular surgery (cataract and refractive), and DM seem to significantly affect donor corneal ECD. Of these variables, age, a history of cataract surgery, and DM were found to be the greatest risk factors for inadequate donor cell density (less than 2000/mm).

The impact of donor age and endothelial cell density on graft survival following penetrating keratoplasty.

PURPOSE: To determine if donor age and preoperative endothelial cell density (ECD) affect corneal endothelial failure following penetrating keratoplasty (PK). METHODS: Preoperative and postoperative data for PKs performed in the UK between April 1999 and March 2012 were analysed. Donor age was split into three groups (0-60, 61-75 and >75 years) and donor ECD was split into three groups (≤2400, 2401-2600 and >2600 cells/mm2). Cox proportional hazards regression was used to determine whether the selected subgroups of donor age and donor ECD have an impact on endothelial failure and a systematic analysis of the interaction between donor ECD and donor age was conducted. The analysis was stratified for primary corneal diagnosis (Fuchs endothelial dystrophy (FED), pseudophakic bullous keratopathy (PBK) and other) and corrected for potentially confounding factors (human leukocyte antigen matching, donor trephine diameter, deep vascularisation, the occurrence of reversible rejection episodes and receipt of systemic antiviral medication, long-term steroids or other immunosuppressive agents). RESULTS: A total of 9415 patients, from the National Health Service Blood and Transplant UK Transplant Registry, who received their first PK for visual reasons were included in this study. The overall 5-year graft survival rate due to endothelial failure was 89%. Survival rates in recipients with FED, PBK and 'all other indications' were 95%, 83% and 89%, respectively. Our analysis shows that donor ECD did not affect outcome following corneal graft within the preselected categories, irrespective of diagnosis and after allowing for any potential confounding factors. Furthermore, HRs for each level of donor ECD, relative to >2600 cells/mm2, for each combination of age group and indication, were not statistically significant. CONCLUSIONS: We were unable to detect a significant effect of donor age, up to 90 years, and preoperative donor ECD, above the lower limit of 2200 cells/mm2, on endothelial failure at 5 years following PK.

Endothelial cell loss and complication rates with combined Descemets stripping endothelial keratoplasty and cataract surgery in a UK centre.

PURPOSE: To report 6-month, 1- and 2-year endothelial cell loss (ECL), intra- and postoperative complications in a large series of patients undergoing either Descemets stripping endothelial keratoplasty (DSEK) or a combined phacoemulsification and DSEK in a UK centre. PATIENTS AND METHODS: Patients undergoing DSEK with or without concurrent cataract surgery were included in this retrospective study. Surgeries were performed between January 2006 and May 2013. Main outcomes included intra- and postoperative complications and percentage ECL. RESULTS: DSEK was performed in 226 eyes (210 patients). Of these, 141 eyes (126 patients) underwent DSEK alone and 85 eyes (84 patients) underwent DSEK combined with cataract surgery. Excluding complex anterior segment pathology the mean percentage ECL at 6, 12 and 24 months was 40.5±13.4, 45.1±14.6 and 53.1±13.0 in the DSEK group and 40.7±15.4, 42.6±15.3 and 49.6±16.5 in patients undergoing the combined procedure, respectively. There was no significant difference in percentage ECL at 6 or 24 months between the two groups both in complex and routine cases. Intraoperative complications occurred in four patients undergoing DSEK and three undergoing combined procedure. Postoperative complication rates did not reach statistical significance between the groups. CONCLUSION: Mean ECL and complication rates were comparable at 6, 12 and 24 months in routine cases undergoing concurrent DSEK with cataract surgery and those undergoing DSEK. These data support the combined procedure in patients requiring both cataract surgery and endothelial keratoplasty. Further collaboration to report endothelial cell counts from other UK centres should be encouraged.

Descemet's stripping endothelial keratoplasty five-year graft survival and endothelial cell loss.

PURPOSE: To assess 5-year Descemet's stripping endothelial keratoplasty (DSEK) graft survival and endothelial cell loss in the surviving grafts. DESIGN: Retrospective, interventional case series. PARTICIPANTS: One hundred sixty-five eyes of 149 patients treated with primary DSEK. METHODS: Donor corneal-scleral rims were dissected manually or with a microkeratome and were cut with a trephine. The graft was folded endothelial side inward and was inserted with forceps through a 5-mm incision. The cumulative probability of secondary graft failure was calculated using Kaplan-Meier survival analysis and the log-rank test. Endothelial cell density (ECD) was determined from baseline preoperative donor and 1-year, 3-year, and 5-year postoperative central endothelial images. MAIN OUTCOME MEASURES: Graft survival and ECD at 5 years. RESULTS: The median recipient age was 71 years (range, 22-90 years) and 62% were female. Eighteen eyes (11%) were treated for pseudophakic or aphakic corneal edema and 147 eyes (89%) were treated for Fuchs' dystrophy. The cumulative 5-year survival rate was significantly lower in pseudophakic or aphakic corneal edema eyes (76%) versus Fuchs' eyes (95%; P = 0.0087). In particular, the 5-year survival rate was reduced significantly in eyes with prior glaucoma shunt or trabeculectomy surgery vs. those without (40% vs. 95%; P<0.0001). The causes of secondary graft failure were endothelial decompensation in 6 eyes (3.6%) and unsatisfactory corrected distance acuity (20/60 to 20/100) in 4 eyes (2.4%). No grafts experienced traumatic wound rupture or failed as a result of ocular surface complications. The median 5-year endothelial cell loss was 53% (range, 7.5%-89%). The 5-year graft ECD was correlated weakly with the baseline donor ECD (r = 0.22 and P = 0.04) and was not significantly correlated with recipient gender (P = 0.075), age (P = 0.85), or diagnosis (P = 0.78). CONCLUSIONS: The 5-year graft survival rates for DSEK were similar to those reported for penetrating keratoplasty in the multicenter Cornea Donor Study (95% vs. 93% for Fuchs' dystrophy and 76% vs. 73% for pseudophakic or aphakic corneal edema). Furthermore, the 5-year endothelial cell loss after DSEK compared favorably with that measured after penetrating keratoplasty in the Cornea Donor Study (53% vs. 70%).

1-year follow-up study of endothelial cell density loss after penetrating keratoplasty.

High endothelial cell density (ECD) is essential for the corneal graft clarity. We evaluated ECD loss in 120 eyes that underwent penetrating keratoplasty (PK) in Eye Clinic Svjetlost in a one year follow up period. Patients were divided into 3 groups of high (N = 35), intermediate (N = 31) and low risk (N = 54) for graft failure. Postoperative central endothelial density, coefficient of variation in cell area (polymegathism), percentage of hexagonal cells (pleomorphism) in comparison to preoperative donor cell measurements were determined in the following postoperative time-points of 1, 2, 3, 6, 9 and 12 months. There were no significant differences in the preoperative ECD values, storage time, donor age or surgical procedures between groups. Throughout all time points intermediate group had the greatest statistically significant ECD loss as compared to high and low risk groups. There were no significant differences between high and low risk group. After 12 month post PK, intermediate risk group had 28.38% ECD loss as compared to 24.07% in high and 23.03% ECD loss in low risk group. Coefficient of variation in cell area (CV) was for high risk group 0.34, intermediate 0.40 and low risk 0.31 which was not significantly different between groups. Percentage of plemorphism in high risk was 54%, intermediate 58% and in low risk 48% which was significantly different as compared to other two groups. Our study showed that corneal pathology is among others, very important prognostic factor for ECD after PK. However, longer follow up period is needed.