Risk factors for endothelial cell loss post-keratoplasty

Purpose: Transplant survival following penetrating keratoplasty is determined to a large extent by the course of endothelial cell density loss. Different influencing factors such as organ culture conditions, surgical trauma, exchange between donor and recipient cells, cell ageing and immune reactions can contribute to endothelial cell loss. The aim of this study was to determine the rate of endothelial cell loss in our patients and to detect dependencies on donor-and recipient-related factors. Methods: Using non-contact specular microscopy, endothelial cell counts were obtained every 6 months from 293 consecutive patients who underwent keratoplasty in our institution between 1996 and 2000. Follow-up time was 36 months. Results: In comparison with the density of donor endothelial cells, the mean endothelial cell loss of patients was 28.8% after 6 months, 39.8% after 12 months and 49% after 24 months. Donor age and initial cell density did not have a significant influence on the course of endothelial cell loss. The lowest rate of endothelial cell loss was associated with patients diagnosed with keratoconus. Conversely, those with preoperative glaucoma had a significantly increased rate of endothelial cell loss (p < 0.05). Conclusions: This study shows that preoperative glaucoma is a major risk factor for increased endothelial cell loss following keratoplasty.