The Histology of Graft Adhesion in Descemet Stripping with Automated Endothelial Keratoplasty
Factors Affecting Regrafts in Endothelial Keratoplasty
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Transcript of Factors Affecting Regrafts in Endothelial Keratoplasty
Cullen Eye InstituteCullen Eye InstituteDepartment of OphthalmologyDepartment of Ophthalmology
Baylor College of MedicineBaylor College of MedicineHouston, TexasHouston, Texas
Jennifer Li, MD, Russell Roberts, CEBT, Jennifer Li, MD, Russell Roberts, CEBT, Kirk R. Wilhelmus, MD, PhDKirk R. Wilhelmus, MD, PhD
Factors Affecting Factors Affecting Regrafts in Endothelial Regrafts in Endothelial
KeratoplastyKeratoplasty
Study PurposeStudy Purpose
To evaluate the frequency of corneal regrafting To evaluate the frequency of corneal regrafting
(either through repeat endothelial keratoplasty or (either through repeat endothelial keratoplasty or
conversion to penetrating keratoplasty) after conversion to penetrating keratoplasty) after
endothelial keratoplasty using donor eye tissue endothelial keratoplasty using donor eye tissue
distributed by the Lions Eye Bank of Texas at Baylor distributed by the Lions Eye Bank of Texas at Baylor
College of MedicineCollege of Medicine
To explore possible reasons for regraftingTo explore possible reasons for regrafting
MethodsMethods Retrospective, cohort studyRetrospective, cohort study
Reviewed donor corneas distributed by a single eye Reviewed donor corneas distributed by a single eye bank for endothelial keratoplasty from January 2004 bank for endothelial keratoplasty from January 2004 through April 2008through April 2008
Regression analysis was performed to evaluate Regression analysis was performed to evaluate possible factors contributing to regrafts including:possible factors contributing to regrafts including: Corneal donor and recipient demographicsCorneal donor and recipient demographics
Donor corneal quality scoreDonor corneal quality score
Corneal endothelial densityCorneal endothelial density
Donor tissue preservation timesDonor tissue preservation times
ResultsResults
From January 2004 through April 2008From January 2004 through April 2008 617 eyes underwent an EK procedure 617 eyes underwent an EK procedure
Performed by 25 corneal surgeonsPerformed by 25 corneal surgeons
95 of 617 (15.4%) had a repeat corneal 95 of 617 (15.4%) had a repeat corneal
surgerysurgery 53 of 95 (55.8%) underwent a repeat EK53 of 95 (55.8%) underwent a repeat EK
42 of 95 (44.2%) underwent a subsequent PKP42 of 95 (44.2%) underwent a subsequent PKP
ResultsResults
ResultsResults
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1 - 4 5 - 7 8 - 10 > 10
Storage Duration in Days
Reoperation
Single EK
ResultsResults
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f Su
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Excellent orvery good
Good
Donor Tissue Rating
Failed first EK
Successful first EK
ResultsResults
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Num
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of S
urge
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2004-2005 2006-2008
Year of Surgery
Reoperation
Single EK
ResultsResults
DiscussionDiscussion
With the emergence of endothelial keratoplasty as a With the emergence of endothelial keratoplasty as a
treatment for endothelial disease, the popularity of this treatment for endothelial disease, the popularity of this
procedure among ophthalmic surgeons has risen procedure among ophthalmic surgeons has risen
dramatically over the past four yearsdramatically over the past four years
The technique is still in evolution as is our The technique is still in evolution as is our
understanding of the factors that contribute to graft understanding of the factors that contribute to graft
dislocation, endothelial cell loss, and ultimately, to dislocation, endothelial cell loss, and ultimately, to
primary graft failure.primary graft failure.
ConclusionsConclusions Four possible risk factors for EK failure were observed in Four possible risk factors for EK failure were observed in
this study:this study:1)1) Donor tissue ratingDonor tissue rating
2)2) Storage duration (interval from preservation to surgery)Storage duration (interval from preservation to surgery)
3)3) Year of surgeryYear of surgery
4)4) SurgeonSurgeon
Multivariate analysis shows that after adjusting for confounding Multivariate analysis shows that after adjusting for confounding
variables, the only significant risk factor was the interval between variables, the only significant risk factor was the interval between
preservation and surgerypreservation and surgery
Study limitations:Study limitations:1)1) Not an all-encompassing data set Not an all-encompassing data set data comes from a single eye bank; some data comes from a single eye bank; some
surgeons may be obtaining donor tissue from other sourcessurgeons may be obtaining donor tissue from other sources
2)2) Unable to take into account all surgical variablesUnable to take into account all surgical variables
3)3) Missing data (donor tissue rating and/or preservation times)Missing data (donor tissue rating and/or preservation times)