Endothelial morphometric measures to predict endothelial graft failure after penetrating keratoplasty

Beth Ann Benetz, Jonathan H. Lass, Robin L. Gal, Alan Sugar, Harry Menegay, Mariya Dontchev, Craig Kollman, Roy W. Beck, Mark J Mannis, Edward J. Holland, Mark Gorovoy, Sadeer B. Hannush, John E. Bokosky, James W. Caudill

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)601-608
Number of pages8
JournalJAMA Ophthalmology
Issue number5
StatePublished - May 2013

ASJC Scopus subject areas

  • Ophthalmology


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