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Current Ophthalmology Reports

, Volume 6, Issue 3, pp 191–199 | Cite as

Clinical Factors for Early and Late Endothelial Cell Loss After Corneal Transplantation

  • Marianne O. Price
  • Jonathan H. Lass
  • Francis W. PriceJr
Cornea (P Hamrah and T Yamaguchi, Section Editors)
  • 14 Downloads
Part of the following topical collections:
  1. Topical Collection on Cornea

Abstract

Purpose of Review

To consider the relative importance of factors associated with post-keratoplasty endothelial cell loss.

Recent Findings

Lamellar keratoplasty continues to supplant penetrating keratoplasty. When host endothelium is healthy, retaining it with deep anterior lamellar keratoplasty significantly reduces long-term endothelial cell loss. Endothelial keratoplasty and penetrating keratoplasty differ fundamentally in relative rates of early and late central endothelial cell loss, yet at 10 years, their cumulative cell loss is similarly substantial. The greatest risk factor for post-keratoplasty endothelial decompensation is prior glaucoma filtration surgery, particularly an aqueous shunt. Interestingly, vital dye staining and sophisticated imaging software suggest that the actual viable endothelial cell density of donor corneas is often overestimated by specular microscopy, inflating estimates of early cell loss.

Summary

Corneal graft longevity is often determined by endothelial cell survival. Adoption of new surgical techniques has improved graft survival, and new imaging techniques allow more accurate preoperative endothelial cell evaluation.

Keywords

Penetrating keratoplasty Endothelial keratoplasty Anterior lamellar keratoplasty Endothelial cell loss Specular microscopy Eye bank 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Thompson RW, Price MO, Bowers PJ, Price FW. Long-term graft survival after penetrating keratoplasty. Ophthalmology. 2003;110:1396–402.CrossRefPubMedGoogle Scholar
  2. 2.
    Joyce NC. Proliferative capacity of the corneal endothelium. Prog Retin Eye Res. 2003;22:359–89.CrossRefPubMedGoogle Scholar
  3. 3.
    Joyce NC, Harris DL, Mello DM. Mechanisms of mitotic inhibition in corneal endothelium: contact inhibition and TGF-beta2. Invest Ophthalmol Vis Sci. 2002;43:2152–9.PubMedGoogle Scholar
  4. 4.
    Bourne WM, Nelson LR, Hodge DO. Central corneal endothelial cell changes over a ten-year period. Invest Ophthalmol Vis Sci. 1997;38:779–82.PubMedGoogle Scholar
  5. 5.
    Bourne WM, Nelson LR, Hodge DO. Continued endothelial cell loss ten years after lens implantation. Ophthalmology. 1994;101:1014–23.CrossRefPubMedGoogle Scholar
  6. 6.
    Bourne WM, Hodge DO, Nelson LR. Corneal endothelium five years after transplantation. Am J Ophthalmol. 1994;118:185–96.CrossRefPubMedGoogle Scholar
  7. 7.
    Price MO, Fairchild KM, Price FW. Comparison of manual and automated endothelial cell density analysis in normal eyes and DSEK eyes. Cornea. 2013;32:567–73.CrossRefPubMedGoogle Scholar
  8. 8.
    Huang J, Maram J, Tepelus TC, Modak C, Marion K, Sadda SR, et al. Comparison of manual and automated analysis methods for corneal endothelial cell density measurements by specular microscopy. J Optom 2017;S1888–4296(17):30049–30043.Google Scholar
  9. 9.
    Benetz BA, Lass JH, Gal RL, Sugar A, Menegay H, Dontchev M, et al. Endothelial morphometric measures to predict endothelial graft failure after penetrating keratoplasty. JAMA Ophthalmol. 2013;131:601–8.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Amann J, Holley GP, Lee SB, Edelhauser HF. Increased endothelial cell density in the paracentral and peripheral regions of the human cornea. Am J Ophthalmol. 2003;135:584–90.CrossRefPubMedGoogle Scholar
  11. 11.
    Jardine GJ, Holiman JD, Stoeger C, Chamberlain WD. Imaging and quantification of endothelial cell loss in eye bank prepared DMEK grafts using trainable segmentation software. Curr Eye Res. 2014;39:894–901.CrossRefPubMedGoogle Scholar
  12. 12.
    •• Bhogal M, Lwin CN, Seah XY, Murugan E, Adnan K, Lin SJ. Real-time assessment of corneal endothelial cell damage following graft preparation and donor insertion for DMEK. PLoS One. 2017;12:e0184824. This study reported methods of vital dye staining and image analysis for more accurate assessment of cell loss associated with different keratoplasty techniques. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    •• Bhogal M, Balda MS, Matter K, Allan BD. Global cell-by-cell evaluation of endothelial viability after two methods of graft preparation in Descemet membrane endothelial keratoplasty. Br J Ophthalmol. 2016;100:572–8. This study showed that eye bank estimations of central endothelial cell density overestimate the actual viable cell density after EK tissue preparation. CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    • AS G, Garcin T, Thuret G, He Z, Jullienne R, Trone MC, et al. Very early endothelial cell loss after penetrating keratoplasty with organ-cultured corneas. Br J Ophthalmol. 2017;101:1113–8. Using vital dye staining and sophisticated imaging software, this study showed that the viable endothelial cell density of the donor graft was substantially less than the specular microscopy reading reported by the eye bank. CrossRefGoogle Scholar
  15. 15.
    • Kitazawa K, Inatomi T, Tanioka H, Kawasaki S, Nakagawa H, Hieda O, et al. The existence of dead cells in donor corneal endothelium preserved with storage media. Br J Ophthalmol. 2017;101:1725–30. This study found mean dead cell rate was 5% in donor corneas stored in cold storage media. CrossRefPubMedGoogle Scholar
  16. 16.
    Borderie VM, Sandali O, Bullet J, Gaujoux T, Touzeau O, Laroche L. Long-term results of deep anterior lamellar versus penetrating keratoplasty. Ophthalmology. 2012;119:249–55.CrossRefPubMedGoogle Scholar
  17. 17.
    Riddlesworth TD, Kollman C, Lass JH, Patel SV, Stulting RD, Benetz BA, et al. A mathematical model to predict endothelial cell loss following penetrating keratoplasty with selective dropout from graft failure. Invest Ophthalmol Vis Sci. 2014;55:8409–15.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Price MO, Calhoun P, Kollman C, Price FW Jr, Lass JH. Descemet stripping endothelial keratoplasty: ten-year endothelial cell loss compared with penetrating keratoplasty. Ophthalmology. 2016;123:1421–7. This study used sophisticated statistical methods to model 10-year endothelial cell loss after DSEK and compared the results with 10-year cell loss after penetrating keratoplasty procedures performed in the multi-center Cornea Donor Study for similar indications. CrossRefPubMedGoogle Scholar
  19. 19.
    Birnbaum F, Reinhard T, Bohringer D, Sundmacher R. Endothelial cell loss after autologous rotational keratoplasty. Graefes Arch Clin Exp Ophthalmol. 2005;243:57–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Matsuda M, Manabe R. The corneal endothelium following autokeratoplasty. A case report. Acta Ophthalmol (Copenh). 1988;66:54–7.CrossRefGoogle Scholar
  21. 21.
    Martinez JD, Galor A, Perez VL, Karp CL, Yoo SH, Alfonso EC. Endothelial graft failure after contralateral autologous corneal transplantation. Cornea. 2013;32:745–50.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    •• Cheng YY, Visser N, Schouten JS, Wijdh RJ, Pels E, van Cleynenbreugel H, et al. Endothelial cell loss and visual outcome of deep anterior lamellar keratoplasty versus penetrating keratoplasty: a randomized multicenter clinical trial. Ophthalmology. 2011;118:302–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Price MO, Gupta P, Lass J, Price FW Jr. EK (DLEK, DSEK, DMEK): new frontier in cornea surgery. Annu Rev Vis Sci. 2017;3:69–90. A comprehensive review of the evolution and current status of endothelial keratoplasty. CrossRefPubMedGoogle Scholar
  24. 24.
    Armitage JW, Dick AD, Bourne WM. Predicting endothelial cell loss and long-term corneal graft survival. Invest Ophthalmol Vis Sci. 2003;44:3326–31.CrossRefPubMedGoogle Scholar
  25. 25.
    •• Sugar A, Gal RL, Kollman C, Raghinaru D, Dontchev M, Croasdale C, et al. Factors predictive of corneal graft survival in the Cornea Donor Study. JAMA Ophthalmol. 2015;133:246–54. This multi-center study assessed the factors predictive of penetrating keraotplasty survival for treatment of Fuchs’ dystrophy and pseudophakic or aphakic corneal edema. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Quilendrino R, Hohn H, Tse WH, Chi H, Dapena I, Ham L, et al. Do we overestimate the endothelial cell “loss” after Descemet membrane endothelial keratoplasty. Curr Eye Res. 2013;38:260–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Price MO, Gorovoy M, Price FW, Benetz BA, Menegay HJ, Lass JH. Descemet’s stripping automated endothelial keratoplasty: three-year graft and endothelial cell survival compared with penetrating keratoplasty. Ophthalmology. 2013;120:246–51.CrossRefPubMedGoogle Scholar
  28. 28.
    Dapena I, Ham L, Droutsas K, van Dijk K, Moutsouris K, Melles GR. Learning curve in Descemet’s membrane endothelial keratoplasty: first series of 135 consecutive cases. Ophthalmology. 2011;118:2147–54.CrossRefPubMedGoogle Scholar
  29. 29.
    Gorovoy MS. DMEK complications. Cornea. 2014;33:101–4.CrossRefPubMedGoogle Scholar
  30. 30.
    Rose-Nussbaumer J, Alloju S, Chamberlain W. Clinical outcomes of Descemet membrane endothelial keratoplasty during the surgeon learning curve versus Descemet stripping endothelial keratoplasty performed at the same time. J Clin Exp Ophthalmol 2016;7(5).pii:599.Google Scholar
  31. 31.
    Phillips PM, Phillips LJ, Muthappan V, Maloney CM, Carver CN. Experienced DSAEK surgeon’s transition to DMEK: outcomes comparing the last 100 DSAEK surgeries with the first 100 DMEK surgeries exclusively using previously published techniques. Cornea. 2017;36:275–9.PubMedGoogle Scholar
  32. 32.
    Debellemaniere G, Guilbert E, Courtin R, Panthier C, Sabatier P, Gatinel D, et al. Impact of surgical learning curve in Descemet membrane endothelial keratoplasty on visual acuity gain. Cornea. 2017;36:1–6.CrossRefPubMedGoogle Scholar
  33. 33.
    Feng MT, Price MO, Miller JM, Price FW Jr. Air reinjection and endothelial cell density in Descemet membrane endothelial keratoplasty: five-year follow-up. J Cataract Refract Surg. 2014;40:1116–21.CrossRefPubMedGoogle Scholar
  34. 34.
    Heinzelmann S, Bohringer D, Eberwein P, Reinhard T, Maier P. Outcomes of Descemet membrane endothelial keratoplasty, Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty from a single centre study. Graefes Arch Clin Exp Ophthalmol. 2016;254:515–22.CrossRefPubMedGoogle Scholar
  35. 35.
    Tourtas T, Laaser K, Bachmann BO, Cursiefen C, Kruse FE. Descemet membrane endothelial keratoplasty versus Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2012;153:1082–90.CrossRefPubMedGoogle Scholar
  36. 36.
    Lee WB, Jacobs DS, Musch DC, Kaufman SC, Reinhart WJ, Shtein RM. Descemet’s stripping endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology. Ophthalmology. 2009;116:1818–30.CrossRefPubMedGoogle Scholar
  37. 37.
    •• SX D, Lee WB, Hammersmith KM, Kuo AN, Li JY, Shen JF, et al. Descemet membrane endothelial keratoplasty: safety and outcomes: a report by the American Academy of Ophthalmology. Ophthalmology. 2018;125:295–310. Comprehensive review and assessment of DMEK. CrossRefGoogle Scholar
  38. 38.
    Gerber-Hollbach N, Baydoun L, Lopez EF, Frank LE, Dapena I, Liarakos VS, et al. Clinical outcome of rebubbling for graft detachment after Descemet membrane endothelial keratoplasty. Cornea. 2017;36:771–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Lass JH, Szczotka-Flynn LB, Ayala AR, Benetz BA, Gal RL, Aldave AJ, et al. Cornea preservation time study: methods and potential impact on the cornea donor pool in the United States. Cornea. 2015;34:601–8.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Guell JL, Morral M, Gris O, Elies D, Manero F. Comparison of sulfur hexafluoride 20% versus air tamponade in Descemet membrane endothelial keratoplasty. Ophthalmology. 2015;122:1757–64.CrossRefPubMedGoogle Scholar
  41. 41.
    Schaub F, Enders P, Snijders K, Schrittenlocher S, Siebelmann S, Heindl LM, et al. One-year outcome after DMEK comparing sulfur hexafluoride (SF6) 20% versus 100% air for anterior chamber tamponade. Br J Ophthalmol. 2017;101:902–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Chaurasia S, Price FW Jr, Gunderson L, Price MO. Descemet’s membrane endothelial keratoplasty: clinical results of single versus triple procedures (combined with cataract surgery). Ophthalmology. 2014;121:454–8.CrossRefPubMedGoogle Scholar
  43. 43.
    Terry MA, Shamie N, Chen ES, Phillips PM, Shah AK, Hoar KL, et al. Endothelial keratoplasty for Fuchs’ dystrophy with cataract: complications and clinical results with the new triple procedure. Ophthalmology. 2009;116:631–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Price MO, Baig KM, Brubaker JW, Price FW Jr. Randomized, prospective comparison of precut versus surgeon-dissected grafts for Descemet stripping automated endothelial keratoplasty. Am J Ophthalmol. 2008;146:36–41.CrossRefPubMedGoogle Scholar
  45. 45.
    Rose L, Briceno CA, Stark WJ, Gloria DG, Jun AS. Assessment of eye bank-prepared posterior lamellar corneal tissue for endothelial keratoplasty. Ophthalmology. 2008;115:279–86.CrossRefPubMedGoogle Scholar
  46. 46.
    Palloura S, Colby K. Outcomes of Descemet stripping endothelial keratoplasty using eye bank-prepared preloaded grafts. Cornea. 2017;36:21–5.CrossRefGoogle Scholar
  47. 47.
    Tran KD, Dye PK, Odell K, Galloway J, Stoeger CG, Straiko MD, et al. Evaluation and quality assessment of prestripped, preloaded Descemet membrane endothelial keratoplasty grafts. Cornea. 2017;36:484–90.CrossRefPubMedGoogle Scholar
  48. 48.
    Ruzza A, Parekh M, Ferrari S, Salvalaio G, Nahum Y, Bovone C, et al. Preloaded donor corneal lenticules in a new validated 3D printed smart storage glide for Descemet stripping automated endothelial keratoplasty. J Ophthalmol. 2015;99:1388–95.Google Scholar
  49. 49.
    Veldman BP, Dye PK, Holiman JD, Mayko ZM, Sales CS, Straiko MD, et al. The S-stamp in Descemet membrane endothelial keratoplasty safely eliminates upside-down graft implantation. Ophthalmology. 2016;123:161–4.CrossRefPubMedGoogle Scholar
  50. 50.
    Anshu A, Price MO, Price FW. Risk of corneal transplant rejection significantly reduced with Descemet’s membrane endothelial keratoplasty. Ophthalmology. 2012;119:536–40.CrossRefPubMedGoogle Scholar
  51. 51.
    • Hos D, Tuac O, Schaub F, Stanzel TP, Schrittenlocher S, Hellmich M, et al. Incidence and clinical course of immune reactions after Descemet membrane endothelial keratoplasty: retrospective analysis of 1000 consecutive eyes. Ophthalmology. 2017;124:512–8. This large single-center study confirmed that DMEK has a remarkably low rate of immunologic rejection. CrossRefPubMedGoogle Scholar
  52. 52.
    Price MO, Price FW Jr, Kruse FE, Bachmann BO, Tourtas T. Randomized comparison of topical prednisolone acetate 1% versus fluorometholone 0.1% in the first year after descemet membrane endothelial keratoplasty. Cornea. 2014;33:880–6.CrossRefPubMedGoogle Scholar
  53. 53.
    • Price MO, Feng MT, Scanameo A, Price FW Jr. Loteprednol etabonate 0.5% gel vs. prednisolone acetate 1% solution after Descemet membrane endothelial keratoplasty: prospective randomized trial. Cornea. 2015;34:853–8. This randomized study showed that topical corticosteroid strength can be reduced 1 month after DMEK to reduce the risk of intraocular pressure elevation without increasing the risk of immunologic graft rejection. CrossRefPubMedGoogle Scholar
  54. 54.
    • Price MO, Scanameo A, Feng MT, Price FW Jr. Descemet’s membrane endothelial keratoplasty: risk of immunologic rejection episodes after discontinuing topical corticosteroids. Ophthalmology. 2016;123:1232–6. This study showed that continued once-daily use of a low-dose topical corticosteroid is protective against immunologic rejection episodes after DMEK. CrossRefPubMedGoogle Scholar
  55. 55.
    Borderie VM, Boelle PY, Touzeau O, Allouch C, Boutboul S, Laroche L. Predicted long-term outcome of corneal transplantation. Ophthalmology. 2009;116:2354–60.CrossRefPubMedGoogle Scholar
  56. 56.
    Anshu A, Price MO, Price FW. Descemet’s stripping endothelial keratoplasty: long-term graft survival and risk factors for failure in eyes with preexisting glaucoma. Ophthalmology. 2012;119:1982–7.CrossRefPubMedGoogle Scholar
  57. 57.
    • Nahum Y, Mimouni M, Busin M. Risk factors predicting the need for graft exchange after Descemet stripping automated endothelial keratoplasty. Cornea. 2015;34:876–9. This study confirmed that prior trabeculectomy or aqueous shunt was a major risk factor for post-keratoplasty endothelial decompensation. CrossRefPubMedGoogle Scholar
  58. 58.
    Aldave AJ, Chen JL, Zaman AS, Deng SX, Yu F. Outcomes after DSEK in 101 eyes with previous trabeculectomy and tube shunt implantation. Cornea. 2014;33:223–9.CrossRefPubMedGoogle Scholar
  59. 59.
    • Kang JJ, Ritterband DC, Lai K, Liebmann JM, Seedor JA. Descemet stripping endothelial keratoplasty in eyes with previous glaucoma surgery. Cornea. 2016;35:1520–5. This study confirmed that the post-keratoplasty risk of endothelial decompensation was increased significantly in eyes with previous aqueous shunt implantation. CrossRefPubMedGoogle Scholar
  60. 60.
    • Yagi-Yaguchi Y, Yamaguchi T, Higa K, Suzuki T, Yazu H, Aketa N, et al. Preoperative aqueous cytokine levels are associated with a rapid reduction in endothelial cells after penetrating keratoplasty. Am J Ophthalmol. 2017;181:166–73. This study showed that higher preoperative aqueous levels of certain cytokines were associated with increased post-keratoplasty endothelial cell loss. CrossRefPubMedGoogle Scholar
  61. 61.
    • Yazu H, Yamaguchi T, Aketa N, Higa K, Suzuki T, Yagi-Yaguchi Y, et al. Preoperative aqueous cytokine levels are associated with endothelial cell loss after Descemet’s stripping automated endothelial keratoplasty. Invest Ophthalmol Vis Sci. 2018;59:612–20. This study showed that higher preoperative aqueous levels of certain cytokines were associated with increased post-keratoplasty endothelial cell loss. CrossRefPubMedGoogle Scholar
  62. 62.
    • Feng MT, Price FW Jr, McKee Y, Price MO. Memantine-associated corneal endothelial dysfunction. JAMA Ophthalmol. 2015;133:1218–20. This study showed that post-keratoplasty endothelial dysfunction can be associated with recipient use of N -methyl- d -aspartate receptor antagonists for Alzheimer’s disease. CrossRefPubMedGoogle Scholar
  63. 63.
    Koenig SB, McDermott ML, Simons KB. Nonimmunologic graft failure after Descemet’s stripping automated endothelial keratoplasty (DSAEK) for presumed amantadine-induced corneal edema. Eye Contact Lens. 2009;35:209–11.CrossRefPubMedGoogle Scholar
  64. 64.
    Lagali N, Stenevi U, Claesson M, Fagerholm P, Hanson C, Weijdegard B. Survival of donor-derived cells in human corneal transplants. Invest Ophthalmol Vis Sci. 2009;50:2673–8.CrossRefPubMedGoogle Scholar
  65. 65.
    Lavy I, Verdijk RM, Bruinsma M, Sleddens H, Oellerich S, Binder PS, et al. Sex chromosome analysis of postmortem corneal endothelium after sex-mismatch Descemet membrane endothelial keratoplasty. Cornea. 2017;36:11–6.CrossRefPubMedGoogle Scholar
  66. 66.
    • Birbal RS, Parker J, Dirisamer M, Janicijevic A, Baydoun L, Dapena I, et al. Descemet membrane endothelial transfer: ultimate outcome. Cornea. 2018;37:141–4. This study showed that endothelial cell migration can result in central corneal clearance despite significant detachment of an endothelial keratoplasty graft, but that ultimately, the cornea decompensates and a regraft is required. CrossRefPubMedGoogle Scholar
  67. 67.
    Gerber-Hollbach N, Parker J, Baydoun L, Liarakos V, Ham L, Dapena I, et al. Preliminary outcome of hemi-Descemet membrane endothelial keratoplasty for Fuchs endothelial dystrophy. Br J Ophthalmol. 2016;100:1564–8.CrossRefPubMedGoogle Scholar
  68. 68.
    Zygoura V, Baydoun L, Ham L, Bourgonje VJA, van Dijk K, Lie JT, et al. Quarter-Descemet membrane endothelial keratoplasty (Quarter-DMEK) for Fuchs endothelial corneal dystrophy: 6 months clinical outcome. Br J Ophthalmol. 2018 ePub ahead of print;  https://doi.org/10.1136/bjophthalmol-2017-311398.
  69. 69.
    Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL. Three-year follow-up of the tube versus trabeculectomy study. Am J Ophthalmol. 2009;148:670–84.CrossRefPubMedGoogle Scholar
  70. 70.
    Anshu A, Price MO, Richardson MR, Segu ZM, Lai X, Yoder MC, et al. Alterations in the aqueous humor proteome in patients with a glaucoma shunt device. Mol Vis. 2011;17:1891–900.PubMedPubMedCentralGoogle Scholar
  71. 71.
    • Rosenfeld C, Price MO, Lai X, Witzmann FA, Price FW Jr. Distinctive and pervasive alterations in aqueous humor protein composition following different types of glaucoma surgery. Mol Vis. 2015;25:911–8. This study showed that different types of glaucoma surgery produce distinctive and pervasive alterations in aqueous humor protein concentrations. Google Scholar
  72. 72.
    • Ishii N, Yamaguchi T, Yazu H, Satake Y, Yoshida A, Shimazaki J. Factors associated with graft survival and endothelial cell density after Descemet’s stripping automated endothelial keratoplasty. Sci Rpt. 2016;6:25276. This study showed that preexisting iris damage can significantly impact corneal endothelial survival. Google Scholar
  73. 73.
    • Price MO, Lisek M, Feng MT, Price FW Jr. Effect of donor and recipient diabetes status on Descemet membrane endothelial keratoplasty adherence and survival. Cornea. 2017;36:1184–8. This study found that recipient diabetes was associated with a higher rate of chronic post-keratoplasty endothelial cell loss. PubMedGoogle Scholar
  74. 74.
    Lass JH, Benetz BA, Gal RL, Kollman C, Raghinaru D, Dontchev M, et al. Donor age and factors related to endothelial cell loss 10 years after penetrating keratoplasty: Specular Microscopy Ancillary Study. Ophthalmology. 2013;120:2428–35.CrossRefPubMedGoogle Scholar
  75. 75.
    •• Lass JH, Benetz BA, Verdier DD, Szczotka-Flynn LB, Ayala AR, Liang W, et al. Corneal endothelial cell loss 3 years after successful Descemet stripping automated endothelial keratoplasty in the Cornea Preservation Time Study: a randomized clinical trial. JAMA Ophthalmol. 2017;135:1394–400. This randomized, multi-center study evaluated the effect of donor preservation time on cell loss after DSEK. CrossRefPubMedGoogle Scholar
  76. 76.
    • Rodriguez-Calvo de Mora M, Groeneveld-van Beek EA, Frank LE, van der Wees J, Oellerich S, Bruinsma M, et al. Association between graft storage time and donor age with endothelial cell density and graft adherence after Descemet membrane endothelial keratoplasty. JAMA Ophthalmol. 2016;134:91–4. This study found that longer donor preservation time in culture medium was associated with increased cell loss after DMEK. CrossRefPubMedGoogle Scholar
  77. 77.
    The Collaborative Corneal Transplantation Studies Research Group. The collaborative corneal transplantation studies (CCTS). Effectiveness of histocompatibility matching in high-risk corneal transplantation. Arch Ophthalmol. 1992;110:1392–403.CrossRefGoogle Scholar
  78. 78.
    Hopkinson CL, Romano V, Kaye RA, Steger B, Stewart RM, Tsagkataki M, et al. The influence of donor and recipient gender incompatibility on corneal transplant rejection and failure. Am J Transplant. 2017;17:210–7.CrossRefPubMedGoogle Scholar
  79. 79.
    •• Price DA, Price MO, Kelley M, Price FW Jr. DMEK vs. DSEK: 5-year graft survival, endothelial cell loss and rejection episode rates, and the effect of donor sex-matching. Ophthalmology. 2018; in press. This study assessed outcomes of over 2000 endothelial keratoplasty procedures; the rejection episode rate was significantly lower with DMEK, but the 5-year graft survival rates were comparable with DMEK and DSEK. Neither donor sex nor donor/recipient sex matching significantly influenced EK outcomes. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Marianne O. Price
    • 1
  • Jonathan H. Lass
    • 2
  • Francis W. PriceJr
    • 3
  1. 1.Cornea Research Foundation of AmericaIndianapolisUSA
  2. 2.University Hospitals Eye InstituteCase Western Reserve UniversityClevelandUSA
  3. 3.Price Vision GroupIndianapolisUSA

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