Abstract
To determine whether measurements of Endothelium/Descemet complex thickness (En/DMT) are of predictive value for corneal graft rejection after high-risk corneal transplantation, we conducted this prospective, single-center, observational case series including sixty eyes (60 patients) at high risk for corneal graft rejection (GR) because of previous immunologic graft failure or having at least two quadrants of stromal vascularization. Patients underwent corneal transplant. At 1st, 3rd, 6th, 9th, and 12th postoperative month, HD-OCT imaging of the cornea was performed, and the corneal status was determined clinically at each visit by a masked cornea specialist. Custom-built segmentation tomography algorithm was used to measure the central En/DMT. Relationships between baseline factors and En/DMT were explored. Time dependent covariate Cox survival regression was used to assess the effect of post-operative En/DMT changes during follow up. A longitudinal repeated measures model was used to assess the relationship between En/DMT and graft status. Outcome measures included graft rejection, central Endothelium/Descemet’s complex thickness, and central corneal thickness (CCT). In patients with GR (35%), the central En/DMT increased significantly 5.3 months (95% CI: 2, 11) prior to the clinical diagnosis of GR, while it remained stable in patients without GR. During the 1-year follow up, the rejected grafts have higher mean pre-rejection En/DMTs (p = 0.01), compared to CCTs (p = 0.7). For En/DMT ≥ 18 µm cut-off (at any pre-rejection visit), the Cox proportional hazard ratio was 6.89 (95% CI: 2.03, 23.4; p = 0.002), and it increased to 9.91 (95% CI: 3.32, 29.6; p < 0.001) with a ≥ 19 µm cut-off. In high-risk corneal transplants, the increase in En/DMT allowed predicting rejection prior to the clinical diagnosis.
Highlights
Abbreviations En/DM Endothelium-Descemet’s complex endothelial/Descemet membrane complex thickness (En/DMT) Endothelium-Descemet’s complex thickness TCT Total corneal thickness central corneal thickness (CCT) Central corneal thickness HD-OCT High-definition optical coherence tomography anterior segment OCT (AS-OCT) Anterior segment optical coherence tomography ROC Receiver operating characteristics AUC Area under curve OCV Optimal cut-off value PK Penetrating corneal transplant DSAEK Descemet stripping automated endothelial corneal transplant
We report on the use of segmental tomography algorithm, and examine the relationship between the central three-dimensional (3D) En/DMT and graft rejection in this population at high risk for rejection
There is no rejected 12-month En/DMT or CCT means because the last pre-rejection values were measured at 9 months
Summary
Abbreviations En/DM Endothelium-Descemet’s complex En/DMT Endothelium-Descemet’s complex thickness TCT Total corneal thickness CCT Central corneal thickness HD-OCT High-definition optical coherence tomography AS-OCT Anterior segment optical coherence tomography ROC Receiver operating characteristics AUC Area under curve OCV Optimal cut-off value PK Penetrating corneal transplant DSAEK Descemet stripping automated endothelial corneal transplant. Despite the use of immunosuppressants, graft failure rate secondary to a rejection varies from 5% in low-risk penetrating corneal transplant (PK) after five years to 35% in high-risk PK at three y ears[1]. We developed and validated a segmental tomography algorithm to generate 3D thickness maps of different corneal layers using AS-OCT corneal scans to enhance the diagnosis of different corneal diseases[12,13,14,15] Using this tool, the three-dimensional thickness of the endothelial/Descemet membrane complex has shown excellent sensitivity and specificity in diagnosing corneal graft rejection that strongly correlated with the rejection severity[13]. We report on the use of segmental tomography algorithm, and examine the relationship between the central three-dimensional (3D) En/DMT and graft rejection in this population at high risk for rejection
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