Abstract
Aim This retrospective investigated the impact of donor age, recipient age, donor endothelial
cell density, vis-à-tergo, and additional intraoperative lens exchange (triple-procedure)
on overall early and late phase postoperative endothelial cell density (ECD) following
penetrating keratoplasty (PKP) in various diagnosis groups.
Patients and Methods In 590 cases with diagnosed keratoconus (KC), Fuchs dystrophy (FD) and herpes simplex
virus infection (HSV) who underwent PKP or triple surgery, the ECD in cells/mm2 was analysed, both preoperatively, with all-sutures-in (early postoperative stage),
and after last suture removal. The factors were tested by Mann-Whitney U-test, correlation
analysis and linear regression analysis.
Outcome Correlation analysis demonstrated a weak negative correlation between the patientʼs
ECD and donor age (early postoperative stage: r = − 0.25, p < 0.001; after last suture
removal: r = − 0.16; p = 0.003). Regression analysis revealed that donor age did not
impact postoperative patient ECD. There was a weak negative correlation between postoperative
ECD and recipient age (early postoperative stage: r = − 0.31, p < 0.001; after last
suture removal: r = − 0.34, p < 0.001). Regression analysis confirmed the negative
impact of recipient age on patient ECD (early postoperative stage: β = − 13.2, p = 0.001;
after last suture removal: β = − 4.6, p < 0.001). Correlation analysis determined
a weak positive correlation between postoperative ECD and donor endothelial cell density
(early postoperative stage: r = 0.37, p < 0.001; after last suture removal: r = 0.32,
p < 0.001). Regression analysis also determined that donor endothelial cell density
had
a positive impact on postoperative ECD following last suture removal (β = 0.4,
p < 0.001). Vis-à-tergo and additional lens exchange (triple procedure) had no significant
effect on postoperative ECD (p > 0.05). This was also confirmed by the results of
the regression analysis after last suture removal.
Conclusion Recipient age and donor endothelial cell density have a significant impact on postoperative
ECD following PKP. Not all of the statistical tests proved donor age to be a significant
influencing factor. Vis-à-tergo and additional lens exchange (triple procedure) had
no significant effect on postoperative ECD following PKP.
Key words
keratoplasty - cornea - endothelium - keratoconus - Fuchs dystrophy - herpetic keratitis
