Endothelial cell density to predict endothelial graft failure after penetrating keratoplasty

Jonathan H. Lass, Alan Sugar, Beth Ann Benetz, Roy W. Beck, Mariya Dontchev, Robin L. Gal, Craig Kollman, Robert Gross, Ellen Heck, Edward J. Holland, Mark J. Mannis, Irving Raber, Walter Stark, R. Doyle Stulting

Research output: Contribution to journalArticlepeer-review

69 Scopus citations


Objective: To determine whether preoperative and/or postoperative central endothelial cell density (ECD) and its rate of decline postoperatively are predictive of graft failure caused by endothelial decompensation following penetrating keratoplasty to treat a moderate-risk condition, principally, Fuchs dystrophy or pseudophakic corneal edema. Methods: In a subset of Cornea Donor Study participants, a central reading center determined preoperative and postoperative ECD from available specular images for 17 grafts that failed because of endothelial decompensation and 483 grafts that did not fail. Results: Preoperative ECD was not predictive of graft failure caused by endothelial decompensation (P=.91). However, the 6-month ECD was predictive of subsequent failure (P<.001). Among those that had not failed within the first 6 months, the 5-year cumulative incidence (±95% confidence interval) of failure was 13% (±12%) for the 33 participants with a 6-month ECD of less than 1700 cells/mm2 vs 2%(±3%) for the 137 participants with a 6-monthECDof 2500 cells/mm2 or higher. After 5 years' follow-up, 40 of 277 participants (14%) with a clear graft had an ECD below 500 cells/mm2. Conclusions: Preoperative ECD is unrelated to graft failure from endothelial decompensation, whereas there is a strong correlation of ECD at 6 months with graft failure from endothelial decompensation. A graft can remain clear after 5 years even when the ECD is below 500 cells/mm2. Clinical Trial Registry: clinicaltrials.gov Identifier: NCT00006411.

Original languageEnglish (US)
Pages (from-to)63-69
Number of pages7
JournalArchives of ophthalmology
Issue number1
StatePublished - Jan 2010
Externally publishedYes

ASJC Scopus subject areas

  • Ophthalmology


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