Donor age and corneal endothelial cell loss 5 years after successful corneal transplantation
Donor age and corneal endothelial cell loss 5 years after successful corneal transplantation
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DOI：
10.1016/j.ophtha.2008.01.004
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发表时间：
2008-04-01
期刊：
影响因子：
13.7
通讯作者：
Verdier, David D.
中科院分区：
文献类型：
--
作者：
Lass, Jonathan H.;Gal, Robin L.;Verdier, David D.
目的：确定角膜移植成功后5年内皮细胞丢失是否与供体年龄有关。设计：多中心，前瞻性，双盲临床试验。参与者：347名参与角膜供体研究的受试者，他们在角膜移植后5年没有经历过中度风险条件的移植失败（主要是Fuchs营养不良或人工晶状体角膜水肿）。术前和术后6个月、12个月时获得的供体角膜的镜面反射显微镜图像，然后5年内每年一次提交给中心阅读中心测量内皮细胞密度（ECD）。主要结果测量：5年时的内皮细胞密度。5年时，所有供体年龄的ECD均较基线显著降低。接受12至65岁供体角膜的受试者的研究眼细胞损失中位数为69%，导致5年平均ECD为824个细胞/mm（2）（四分位距，613-1342），而接受来自66至75岁供体的角膜的受试者经历了75%的细胞损失，5年平均ECD为654个细胞/mm 2（四分位数间距538-986）（P [校正基线ECD] = 0.04）。从统计学上看，ECD和供体年龄之间存在弱的负相关，作为连续变量进行分析（r [校正基线ECD] = -0.19; 95%置信区间，-0.29至-0.08）。细胞丢失与供体年龄之间存在轻微相关性。这一发现强调了对该队列进行长期随访以确定这种关系是否影响移植物存活的重要性。
Objective: To determine whether endothelial cell loss 5 years after successful corneal transplantation is related to the age of the donor.Design: Multicenter, prospective, double-masked clinical trial.Participants: Three hundred forty-seven subjects participating in the Cornea Donor Study who had not experienced graft failure 5 years after corneal transplantation for a moderate-risk condition (principally Fuchs' dystrophy or pseudophakic corneal edema).Testing: Specular microscopic images of donor corneas obtained before surgery and postoperatively at 6 months, 12 months, and then annually through 5 years were submitted to a central reading center to measure endothelial cell density (ECD).Main Outcome Measure: Endothelial cell density at 5 years.Results: At 5 years, there was a substantial decrease in ECD from baseline for all donor ages. Subjects who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 69% in the study eye, resulting in a 5-year median ECD of 824 cells/mm(2) (interquartile range, 613-1342), whereas subjects who received a cornea from a donor 66 to 75 years old experienced a cell loss of 75%, resulting in a median 5-year ECD of 654 cells/mm(2) (interquartile range, 538-986) (P [adjusted for baseline ECD] = 0.04). Statistically, there was a weak negative association between ECD and donor age analyzed as a continuous variable (r [adjusted for baseline ECD] = -0.19; 95% confidence interval, -0.29 to -0.08).Conclusions: Endothelial cell loss is substantial in the 5 years after corneal transplantation. There is a slight association between cell loss and donor age. This finding emphasizes the importance of longer-term follow-up of this cohort to determine if this relationship affects graft survival.