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Updated: May 13, 2026
Corneal Donor Tissue Preparation for Descemet's Membrane Endothelial Keratoplasty
Published on: September 17, 2014
Endothelial morphometric measures to predict endothelial graft failure after penetrating keratoplasty
Beth Ann Benetz1, Jonathan H Lass1, Robin L Gal2
1Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH.
Importance:
Endothelial morphometric measures have potential value in predicting graft failure after penetrating keratoplasty.
Objective:
To determine whether preoperative and/or postoperative central morphometric measures (endothelial cell density [ECD], coefficient of variation [CV], and percentage of hexagonality [HEX]) and their postoperative changes are predictive of graft failure caused by endothelial decompensation after penetrating keratoplasty to treat a moderate-risk condition, principally Fuchs dystrophy or pseudophakic corneal edema.
Design:
In a subset of Cornea Donor Study participants with graft failure, a central reading center determined preoperative and postoperative ECD, CV, and HEX from available central endothelial specular images.
Setting:
Cornea Image Analysis Reading Center of the Specular Microscopy Ancillary Study.
Participants:
Eighteen patients with graft failure due to endothelial decompensation and 54 individuals matched for most donor and recipient measures at baseline whose grafts did not fail.
Main Outcome Measure:
Change in ECD, CV, and HEX values.
Results:
Preoperative ECD was not associated with graft failure (P = .43); however, a lower ECD at 6 months was predictive of subsequent failure (P = .004). Coefficient of variation at 6 months was not associated with graft failure in univariate (P = .91) or multivariate (P = .79) analyses. We found a suggestive trend of higher graft failure with lower HEX values at 6 months (P = .02) but not at the established statistical significance (P < .01). The most recent CV or HEX values, as time-dependent variables, were not associated with graft failure (P = .26 and P = .81, respectively). Endothelial cell density values decreased during follow-up, whereas CV and HEX appear to fluctuate without an apparent trend.
Conclusions And Relevance:
Endothelial cell density at 6 months after penetrating keratoplasty is predictive of graft failure, whereas CV and HEX appear to fluctuate postoperatively, possibly indicating an unstable endothelial population in clear and failing grafts.
Trial Registration:
clinicaltrials.gov Identifier: NCT00006411.
