Minimization of Chronic Endothelial Cell Loss in Penetrating Keratoplasty
Reinhard T.1, Böhringer D.2, Sundmacher R.2
1Universitäts-Augenklinik, Albert-Ludwigs-Universität, Freiburg
2Augenklinik der Heinrich-Heine-Universität Düsseldorf
Purpose: Chronic endothelial cell loss is the main cause of late graft survival following penetrating keratoplasty. The influencing factors, therefore, should be identified and optimized.
Method: In a large homogenous group of patients undergoing normal-risk penetrating keratoplasty the influence of donor factors (donor age), culture factors (post mortem time, organ culture period) and host factors (indication for surgery, glaucoma, HLA matching) was analyzed.
Results: Low donor age, short post mortem time, short culture period and well controlled intraocular pressure minimize chronic endothelial cell loss. Probably, high preoperative endothelial cell density improves long-term clear graft survival. In patients with healthy host endothelium chronic endothelial cell loss was statistically significantly lower than in patients with bullous keratopathy. An influence of HLA matching on chronic endothelial cell loss could not yet be shown.
Conclusions: Donor age should be as low and post mortem time and culture period short in order to minimize chronic endothelial cell loss. In patients with bullous keratopathy the use of graft with large diameters possibly may improve long-term clear graft survival. The same is true for well controlled intraocular pressure. Since
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