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Endothelial Cell-loss after Immunological Graft Rejection following Normal-risk-keratoplasty

1Nguyen N. X., 1Cursiefen C., 1Langenbucher A., 2Martus P., 1Seitz B., 1Küchle M.,
1Friedrich-Alexander-Universität, Augenklinik (Erlangen)
2Freie Universität Berlin, Klinikum Benjamin Franklin, Institut für Medizinische Informatik, Biometrie und Epidemiologie (Berlin)

Purpose: The aim of this study was to evaluate the development of corneal endothelial cell loss after endothelial graft rejection (GR) following normal-risk keratoplasyty (PK) in humans.
Patients and Methods: The study included 24 eyes of 24 patients recruited from the prospective Erlangen normal-risk PK study (age 54.7±19.8 years) with graft rejection that fullfilled the following inclusion criteria: 1) diagnosis and treatment of GR in our department and 2) at least one year follow-up after graft rejection. Standardized complete ophthalmological examinations including specular microscopy (EM 1100, TOMEY) were performed on a regular basis before, during the acute graft rejection und then regularily according to a defined examination scheme in a special cornea out-patient service.
Results: The mean endothelial cell density was 1915 ± 466cells/mm² before GR and decreased significantly within the observation period of 6 months and 12 months after GR (1249 ± 406 cells/mm², p<0.0001/ 1023 ± 308 cells/mm², p<0.0001). 20 grafts remained clear with stable best-corrected visual acuity of 0.6±0.3. Only 4 patients (16%) showed an irreversible graft failure. Time intervall between first symptom and start of treatment in patients with clear graft was significantly shorter (6±4 days) than in patients with irreversible graft failure (24±11 days; p=0.002). During the first 6 months period endothelial cell loss was 39±17% in comparison to the values before GR. Thereafter endothelial cell loss continued more slowly compared with the 6-months finding (11±11%).
Conclusions: Even with a clear graft and a good visual acuity after an episode of GR there is significant endothelial cell loss during the first year, which may predispose to late graft failure. The lower reduction of endothelial cells from 6 months after GR may be due to a possible centripetal endothel cell migration from the host cornea.
Support: BMBF (IZKF Erlangen, project B 13)