Donor, Recipient, and Operative Factors Associated With Increased Endothelial Cell Loss in the Cornea Preservation...

Area of Science:

• Ophthalmology
• Corneal Surgery
• Transplantation Science

Background:

• Endothelial cell loss after Descemet stripping automated endothelial keratoplasty (DSAEK) can affect long-term graft survival.
• Identifying factors associated with endothelial cell density (ECD) is crucial for improving outcomes.

Purpose of the Study:

• To investigate the associations of donor, recipient, and operative factors with ECD three years post-DSAEK.
• To analyze endothelial cell loss (ECL) in relation to specific risk factors.

Main Methods:

• Secondary analysis of a multicenter, double-masked, randomized clinical trial (Cornea Preservation Time Study).
• Included 749 participants (913 eyes) with acceptable endothelial images at baseline and 3 years post-DSAEK.
• Evaluated ECD using specular or confocal microscopy; analyzed donor, recipient, and operative variables.

Main Results:

• Factors associated with lower 3-year ECD included donor diabetes, lower preoperative ECD, recipient diagnosis of pseudophakic/aphakic corneal edema (PACE), and operative complications.
• Endothelial cell loss (ECL) was higher in participants receiving tissue from donors with diabetes (47%) compared to those without (43%).
• ECL was also higher for recipients with PACE (53%) versus Fuchs dystrophy (44%) and in cases with operative complications (55%) versus without (44%).

Conclusions:

• Donor diabetes, lower screening ECD, recipient PACE diagnosis, and operative complications are associated with reduced ECD three years after DSAEK.
• These factors may influence long-term graft success, warranting further investigation.
• Causation cannot be inferred, but associations highlight areas for future research.