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
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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：探讨角膜移植成功后5年内皮细胞丢失是否与供者年龄有关。设计：多中心、前瞻性、双盲临床试验。参与者：347名参与角膜移植的受试者，他们在角膜移植后5年内没有发生过中等危险情况(主要是Fuchs营养不良或人工晶状体性角膜水肿)的植片失败。测试：供体角膜在手术前和术后6个月、12个月、12个月、然后每年至5年提交给中央阅读中心测量内皮细胞密度(ECD)。主要结果：5年时内皮细胞密度。结果：5年时，所有供者年龄的内皮细胞密度较基线显著下降。接受12岁至65岁供体角膜的受试者在研究眼中经历了69%的中位细胞丢失，导致5年中位ECD为824个/mm(2)(四分位数范围为613-1342)，而接受66岁至75岁供者角膜的受试者经历了75%的细胞丢失，导致5年内ECD的中位数为654个/mm(2)(四分位数范围538-986)(P[经基线ECD调整]=0.04)。经统计学处理，ECD与供者年龄呈弱负相关(r[调整基线ECD]=-0.19；95%可信区间为-0.29~-0.08)。结论：角膜移植术后5年内内皮细胞大量丢失。细胞丢失与供者年龄之间略有关联。这一发现强调了对这一队列的长期随访的重要性，以确定这种关系是否影响移植物存活。
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.