1. Effect of Graft Attachment Status and Intraocular Pressure on Descemet Stripping Automated Endothelial Keratoplasty Outcomes in the Cornea Preservation Time Study
- Author
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Thomas E. Gillette, Marc F Jones, Bennie H. Jeng, Loretta B Szczotka-Flynn, Irving M. Raber, Christopher J. Rapuano, Shachar Tauber, Kenneth J. Maverick, Jonathan H. Lass, Matthew S Oliva, Maureen G. Maguire, Wendi Liang, Woodford S. Van Meter, Kevin W. Ross, Neda Shamie, John W Seedor, David D. Verdier, Richard L. Lindstrom, Beth Ann Benetz, George O D Rosenwasser, Anthony J. Aldave, Steven P. Dunn, Kristin M. Hammersmith, John E. Bokosky, Verinder S. Nirankari, Christopher G. Stoeger, Mark A. Terry, David R. Hardten, Robert O'Brien, and Allison R Ayala
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Adult ,Graft Rejection ,Male ,Intraocular pressure ,medicine.medical_specialty ,Time Factors ,genetic structures ,Cell Count ,Article ,Cornea ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Risk Factors ,Ophthalmology ,Diabetes mellitus ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Intraocular Pressure ,Aged ,030304 developmental biology ,Aged, 80 and over ,0303 health sciences ,business.industry ,Corneal Edema ,Fuchs' Endothelial Dystrophy ,Graft Survival ,Organ Preservation ,Odds ratio ,Middle Aged ,medicine.disease ,eye diseases ,Dissection ,Treatment Outcome ,medicine.anatomical_structure ,Relative risk ,030221 ophthalmology & optometry ,Female ,sense organs ,business ,Descemet Stripping Endothelial Keratoplasty ,Follow-Up Studies ,Cohort study - Abstract
PURPOSE: To examine the association of donor, recipient, and operative factors on graft dislocation after Descemet stripping automated endothelial keratoplasty (DSAEK) in the Cornea Preservation Time Study (CPTS) as well as the effects of graft dislocation and elevated IOP on graft success and endothelial cell density (ECD) 3 years postoperatively. DESIGN: Cohort study within a multi-center, double-masked, randomized clinical trial. METHODS: 1,090 individuals (1,330 study eyes), median age 70 years, undergoing DSAEK for Fuchs endothelial corneal dystrophy (94% of eyes) or pseudophakic or aphakic corneal edema (6% of eyes). Recipient eyes receiving donor corneal tissue randomized by preservation time (PT) of 0-7 days (N=675) or 8-14 days (N=655) were monitored for early or late graft failure through 3 years. Donor, recipient, operative, and postoperative parameters were recorded including graft dislocation (GD), partial detachment, and pre- and post-operative IOP. Pre- and postoperative central donor ECD were determined by a central image analysis reading center. Proportional hazards, mixed effects, and logistic regression models estimated risk ratios and {99% confidence intervals}. RESULTS: Three independent predictive factors for GD were identified: a history of donor diabetes (odds ratio {OR}: 2.29 {1.30, 4.02}), increased pre-lamellar dissection central corneal thickness (OR: 1.13 {1.01, 1.27} per 25μ increase), and operative complications (OR: 2.97 {1.24, 7.11}). Among 104 (8%) eyes with GD, 30 (28.9%) developed primary donor or early failure and 5 (4.8%) developed late failure vs. 15 (1.2%; p
- Published
- 2019
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