Donor and recipient characteristics associated with rebubbling rate, endothelial cell loss, and graft failure in primary descemet membrane endothelial keratoplasty

Year 2022, , 1461 - 1467, 25.09.2022

Nesrin Tutaş Günaydın , Burak Tanyıldız

https://doi.org/10.32322/jhsm.1158938

Abstract

Aim: To determine whether donor and recipient characteristics are associated with rebubbling rate, endothelial cell loss (ECL), and graft failure 3 years after primary Descemet membrane endothelial keratoplasty (DMEK).
Material and Method: Records of 295 consecutive DMEK surgery and match with corresponding donor data were reviewed at a tertiary referral clinic. Recipients with intraoperative complications and coexisting ocular pathologies were excluded. Age, sex of donor and recipient, cause of donor death, death-to-preservation time (DtPT), storage time, donor endothelial cell density (ECD), and indications for surgery were analyzed for correlation with rebubbling rate, postoperative ECL, and graft failure. Further, subgroup analyses of the cause of death, donor sex, DtPT (median value, 3.5 h), and indications were performed. Multiple regression and receiver operating characteristics (ROC) analysis were used to determine the independent risk factors for graft failure.
Results: This study included 114 eyes that underwent DMEK for bullous keratopathy (BK; 64%) and for Fuchs’ endothelial corneal dystrophy (FECD; 36%). The graft failure percentage was the only parameter that was higher in patients with DtPT > 3.5 h (p=0.047) than those with shorter DtPT. The probability of graft failure was seven times higher in eyes with DtPT > 3.5 h than with shorter DtPT (odds ratio 7.36, 95% confidence interval CI 1.34‒40.53) and 10 times higher in eyes with BK than those with FECD (odds ratio 10.29, 95% CI 1.01‒104.54).
Conclusion:. DtPT and recipients with BK diagnosis were found to be independent risk factors for graft failure. Therefore, surgeons should consider DtPT for DMEK in eyes with BK.

Keywords

Descemet membrane endothelial keratoplasty, death-to-preservation time, graft failure, bullous keratopathy, Fuchs endothelial corneal dystrophy

References

• Melles GRJ, Ong TS, Ververs B, van der Wees J. Descemet membrane endothelial keratoplasty. Cornea 2006; 25: 987-90.
• Sugar J, Montoya M, Dontchev M, et al. Donor risk factors for graft failure in the cornea donor study. Cornea 2009; 28: 981-5.
• Terry MA, Aldave AJ, Szczotka-Flynn LB, et al. Donor, recipient, and operative factors associated with graft success in the cornea preservation time study. Ophthalmology 2018; 125: 1700-9.
• DeMatteo J. Eye Bank Association of America medical standards regarding Ebola policy. JAMA Ophthalmol 2015; 133: 1364.
• Dapena I, Moutsouris K, Droutsas K, Ham L, van Dijk K, Melles GR. Standardized “no-touch” technique for descemet membrane endothelial keratoplasty. Arch Ophthalmol 2011; 129: 88-94.
• Bhogal M, Maurino V, Allan BD. Use of a single peripheral triangular mark to ensure correct graft orientation in descemet membrane endothelial keratoplasty. J Cataract Refract Surg 2015; 41: 2022-4.
• Lass JH, Szczotka-Flynn LB, Ayala AR, et al. Cornea preservation time study: methods and potential impact on the cornea donor pool in the United States. Cornea 2015; 34: 601-8.
• Rodríguez-Calvo de Mora M, Groeneveld-van Beek EA, Frank LE, et al. Association between graft storage time and donor age with endothelial cell density and graft adherence after descemet membrane endothelial keratoplasty. JAMA Ophthalmol 2016; 134: 91-4.
• Heinzelmann S, Hüther S, Böhringer D, Eberwein P, Reinhard T, Maier P. Influence of donor characteristics on descemet membrane endothelial keratoplasty. Cornea 2014; 33: 644-8.
• Straiko MD, Bauer AJ, Straiko MMW, et al. Donor DMEK tissue characteristics: association with rebubble rate and 6-month endothelial cell loss. Cornea 2020; 39: 1267-73.
• Dunker S, Winkens B, van den Biggelaar F, et al. Rebubbling and graft failure in Descemet membrane endothelial keratoplasty: a prospective Dutch registry study. Br J Ophthalmol 2021; bjophthalmol-2020-317041.
• Baydoun L, Ham L, Borderie V, et al. Endothelial survival after descemet membrane endothelial keratoplasty: effect of surgical indication and graft adherence status. JAMA Ophthalmol 2015; 133: 1277-85.
• Oellerich S, Ham L, Frank LE, et al. Parameters associated with endothelial cell density variability after descemet membrane endothelial keratoplasty. Am J Ophthalmol 2020; 211: 22-30.
• Patel SV, Diehl NN, Hodge DO, Bourne WM. Donor risk factors for graft failure in a 20-year study of penetrating keratoplasty. Arch Ophthalmol 2010; 128: 418-25.
• Birbal RS, Ni Dhubhghaill S, Bourgonje VJA, et al. Five-year graft survival and clinical outcomes of 500 consecutive cases after descemet membrane endothelial keratoplasty. Cornea 2020; 39: 290-7.
• Rosenwasser GO, Szczotka-Flynn LB, Ayala AR, et al. Effect of cornea preservation time on success of descemet stripping automated endothelial keratoplasty: a randomized clinical trial. JAMA Ophthalmol 2017; 135: 1401-9.
• Andersen J, Ehlers N. The influence of donor age and post mortem time on corneal graft survival and thickness when employing banked donor material (A five-year follow-up). Acta Ophthalmol 1988; 66: 313-7.
• Mohamed-Noriega K, Mehta JS. Influence of donor age and post-mortem time on the metabolic profile of donor corneas and graft survival. Expert Rev Ophthalmol 2012; 7: 121-5.
• Armitage WJ, Jones MNA, Zambrano I, Carley F, Tole DM, NHSBT Ocular Tissue Advisory Group and Contributing Ophthalmologists OTAG Audit Study 12. The suitability of corneas stored by organ culture for penetrating keratoplasty and influence of donor and recipient factors on 5-year graft survival. Invest Ophthalmol Vis Sci 2014; 55: 784-91.
• Patel D, Tandon R, Ganger A, Vij A, Lalwani S, Kumar A. Study of death to preservation time and its impact on utilisation of donor corneas. Trop Doct 2017; 47: 365-70.
• Böhringer D, Reinhard T, Spelsberg H, Sundmacher R. Influencing factors on chronic endothelial cell loss characterised in a homogeneous group of patients. Br J Ophthalmol 2002; 86: 35-8.
• Langenbucher A, Nguyen NX, Seitz B. Predictive donor factors for chronic endothelial cell loss after nonmechanical penetrating keratoplasty in a regression model. Graefes Arch Clin Exp Ophthalmol 2003; 241: 975-81.
• Writing Committee for the Cornea Donor Study Research Group, Sugar A, Gal RL, Kollman C, et al. Factors associated with corneal graft survival in the cornea donor study. JAMA Ophthalmol 2015; 133: 246-54.
• Bahar Z, Beşer A, Ersin F, Kıssal A, Aydoğdu NG. Traditional and religious death practices in Western Turkey. Asian Nurs Res (Korean Soc Nurs Sci) 2012; 6: 107-14.
• Gavrilov JC, Borderie VM, Laroche L, Delbosc B. Influencing factors on the suitability of organ-cultured corneas. Eye (Lond) 2010; 24: 1227-33.
• Ang M, Soh Y, Htoon HM, Mehta JS, Tan D. Five-year graft survival comparing descemet stripping automated endothelial keratoplasty and penetrating keratoplasty. Ophthalmology 2016; 123: 1646-52.
• Price MO, Fairchild KM, Price DA, Price FW. Descemet’s stripping endothelial keratoplasty five-year graft survival and endothelial cell loss. Ophthalmology 2011; 118: 725-9.
• Terry MA, Shamie N, Straiko MD, Friend DJ, Davis-Boozer D. Endothelial keratoplasty: the relationship between donor tissue storage time and donor endothelial survival. Ophthalmology 2011; 118: 36-40.
• Edelstein SL, DeMatteo J, Stoeger CG, Macsai MS, Wang CH. Report of the Eye Bank Association of America medical review subcommittee on adverse reactions reported from 2007 to 2014. Cornea 2016; 35: 917-26.
• Birbal RS, Baydoun L, Ham L, et al. Effect of surgical indication and preoperative lens status on descemet membrane endothelial keratoplasty outcomes. Am J Ophthalmol 2020; 212: 79-87.
• Shimizu T, Hayashi T, Yuda K, et al. Short axial length and iris damage are associated with iris posterior synechiae after descemet membrane endothelial keratoplasty in Asian eyes. Cornea 2018; 37: 1355-9.
• Beşek NK, Yalçınkaya G, Kırgız A, et al. Graft survival and clinical outcomes of Descemet membrane endothelial keratoplasty: long-term results. Int Ophthalmol 2022; 42: 269-79.
• Shimizu T, Yamagami S, Mizuki N, Hayashi T. Descemet membrane endothelial keratoplasty in Asian eyes. Curr Ophthalmol Rep 2020; 8: 208-15.
• He Z, Campolmi N, Gain P, et al. Revisited microanatomy of the corneal endothelial periphery: new evidence for continuous centripetal migration of endothelial cells in humans. Stem Cells 2012; 30: 2523-34.
• Garcerant D, Hirnschall N, Toalster N, Zhu M, Wen L, Moloney G. Descemet’s stripping without endothelial keratoplasty. Curr Opin Ophthalmol 2019; 30: 275-85.
• Schrittenlocher S, Bachmann B, Cursiefen C. Impact of donor tissue diameter on postoperative central endothelial cell density in descemet membrane endothelial keratoplasty. Acta Ophthalmol 2019; 97: e618-22.
• Ibrahim O, Yagi-Yaguchi Y, Kakisu K, Shimazaki J, Yamaguchi T. Association of iris damage with reduction in corneal endothelial cell density after penetrating keratoplasty. Cornea 2019; 38: 268-74.