Endothelial Cell Density and Central Corneal Thickness following Penetrating Keratoplasty of Acanthamoeba Keratitis Patients – A Retrospective Cross-Sectional Observational Study

Abstract

Purpose To analyze endothelial cell density (ECD) and central corneal thickness (CCT) following penetrating keratoplasty (PKP) in Acanthamoeba keratitis (AK) patients.

Patients and Methods In this retrospective, clinical, single-center, cross-sectional, observational study, patients were enrolled who underwent PKP at the Department of Ophthalmology of Saarland University Medical Center, Homburg/Saar, Germany between May 2008 and December 2016 with the diagnosis of AK. In all, 33 eyes of 33 patients (14 males, 42%) were enrolled; their mean age at the time of surgery was 39.5 ± 14.3 years. Postoperatively, AK patients received topical polyhexamethylene biguanide, propamidine isethionate, neomycin sulphate/gramicidin/polymixin B sulfate, and prednisolone acetate eye drops (5 ×/day each), and the topical treatment was tapered sequentially with 1 drop every 6 weeks over 6 months. CCT was recorded using Pentacam HR Scheimpflug tomography and ECD with the EM-3000 specular microscope before surgery and 3 and 6 months after surgery as well as after the first and second (complete) suture removal.

Results ECD tended to decrease significantly from the time point before surgery (2232 ± 296 cells/mm²) to the time point 3 months after surgery (1914 ± 164 cells/mm²; p = 0.080) and to the time point after the first suture removal (1886 ± 557 cells/mm²; p = 0.066) and decrease significantly to the time point after the second suture removal (1650 ± 446 cells/mm²; p = 0.028). CCT did not change significantly over the analyzed time period (p ≥ 0.475).

Conclusion In AK, endothelial cell loss does not seem to be accelerated following PKP, despite the postoperative use of diamidine and biguanide. A subsequent prospective comparative study should confirm our retrospective longitudinal analysis.

Zusammenfassung

Zweck Analyse der Endothelzelldichte (ECD) und der zentralen Hornhautdicke (CCT) nach perforierender Keratoplastik bei Patienten mit Akanthamöbenkeratitis (AK).

Patienten und Methoden In dieser retrospektiven, klinischen, monozentrischen, observativen Querschnittsstudie wurden die Patienten, die sich zwischen Mai 2008 und Dezember 2016 an der Augenklinik des Universitätsklinikums des Saarlandes in Homburg/Saar, Deutschland, mit der Diagnose einer Akanthamöbenkeratitis einer PKP unterzogen hatten, eingeschlossen. Insgesamt wurden 33 Augen von 33 Patienten (14 Männer, 42%) eingeschlossen, das Alter zum Zeitpunkt der Operation betrug 39,5 ± 14,3 Jahre. Postoperativ erhielten die AK-Patienten topisches Polyhexamethylenbiguanid, Propamidin-Isethionat, Neomycinsulfat/Gramicidin/Polymyxin-B-Sulfat und Prednisolonacetat als Augentropfen (jeweils 5 ×/Tag), wobei die topische Behandlung sequenziell um 1 Tropfen alle 6 Wochen über 6 Monate ausgeschlichen wurde. Die CCT wurde unter Verwendung der Pentacam-HR-Scheimpflug-Tomografie, die ECD mit dem EM-3000-Spiegelmikroskop jeweils vor der Operation sowie 3 und 6 Monate nach der Operation und nach der 1. und 2. (vollständigen) Fadenentfernung erfasst.

Ergebnisse Die ECD zeigte eine abnehmende Tendenz vom Zeitpunkt vor der Operation (2232 ± 296 Zellen/mm²) zum Zeitpunkt 3 Monate nach der Operation (1914 ± 164 Zellen/mm²; p = 0,080) und zum Zeitpunkt nach der 1. Fadenentfernung (1886 ± 557 Zellen/mm²; p = 0,066) sowie eine statistisch signifikante Abnahme zum Zeitpunkt nach der 2. Fadenentfernung (1650 ± 446 Zellen/mm²; p = 0,028). Die CCT veränderte sich über den analysierten Zeitraum nicht signifikant (p ≥ 0,475).

Schlussfolgerung Bei der Akanthamöbenkeratitis scheint der Endothelzellverlust nach PKP trotz der postoperativen Anwendung von Diamidin und Biguanid nicht beschleunigt zu sein. Eine nachfolgende prospektive Vergleichsstudie sollte unsere retrospektive Längsschnittanalyse bestätigen.

Key words

endothelial cell density - corneal thickness - penetrating keratoplasty - Acanthamoeba keratitis - bacterial keratitis - keratoconus

Schlüsselwörter

Endothelzelldichte - Hornhautdicke - durchdringende Keratoplastik - Akanthamöbenkeratitis - bakterielle Keratitis - Keratokonus

Publication History

Received: 16 September 2020

Accepted: 11 January 2021

Article published online:
17 March 2021

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