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Corneal Thickness as a Predictor of Corneal Transplant Outcome

Verdier, David D. MD; Sugar, Alan MD; Baratz, Keith MD; Beck, Roy MD, PhD; Dontchev, Mariya MPH; Dunn, Steven MD; Gal, Robin L. MSPH; Holland, Edward J. MD; Kollman, Craig PhD; Lass, Jonathan H. MD; Mannis, Mark J. MD; Penta, Jeffrey MBAfor the Cornea Donor Study Investigator Group

doi: 10.1097/ICO.0b013e31827b14c7
Clinical Science

Purpose: To assess corneal thickness (CT) and correlation with graft outcome after penetrating keratoplasty in the Cornea Donor Study.

Methods: A total of 887 subjects with a corneal transplant for a moderate-risk condition (principally Fuchs dystrophy or pseudophakic corneal edema) had postoperative CT measurements throughout a 5-year follow-up time. Relationships between baseline (recipient, donor, and operative) factors and CT were explored. Proportional hazards models were used to assess the association between CT and graft failure. Relationship between CT and cell density was assessed with a longitudinal repeated measures model and Spearman correlation estimates.

Results: Higher longitudinal CT measurements were associated with the following: diagnosis of pseudophakic or aphakic corneal edema (P < 0.001), intraocular pressure >25 mm Hg during the first postoperative month (P = 0.003), white (non-Hispanic) donor race (P = 0.002), and respiratory causes of donor death (P < 0.001). Among those without graft failure within the first postoperative year, the 5-year cumulative incidence (±95% confidence interval) of graft failure was 5% ± 5% in those with a 1-year CT ≤500 μm, 5% ± 3% for CT 501 to 550 μm, 7% ± 4% for CT 551 to 600 μm, and 20% ± 11% for CT >600 μm. In a multivariate analysis, both 1-year CT and cell density were associated with subsequent graft failure (P = 0.002 and 0.009). CT increase was modestly associated with endothelial cell loss during follow-up (r = −0.29).

Conclusions: During the first 5 years after penetrating keratoplasty, CT can serve as a predictor of graft survival. However, CT is not a substitute for cell density measurement because both measures were independently predictive of graft failure.

*Verdier Eye Center, Grand Rapids, MI

W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI

Department of Ophthalmology, Mayo Clinic, Rochester, MN

§Jaeb Center for Health Research, Tampa, FL

Michigan Cornea Consultants PC, Southfield, MI

Department of Ophthalmology and Visual Sciences, Cincinnati Eye Institute, Cincinnati, OH

**Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, OH

††University of California Davis, Sacramento, CA

‡‡San Diego Eye Bank, San Diego, CA.

Reprints: David D. Verdier, Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647 (e-mail:

Supported by cooperative agreements with the National Eye Institute, National Institutes of Health, and the Department of Health and Human Services (EY12728 and EY12358). Additional support was provided by Eye Bank Association of America, Bausch & Lomb Inc, Tissue Banks International, Vision Share Inc, San Diego Eye Bank, The Cornea Society, Katena Products Inc, ViroMed Laboratories Inc, Midwest Eye-Banks (Michigan Eye-Bank, Illinois Eye-Bank), Konan Medical Corp, Eye Bank for Sight Restoration, SightLife, Sight Society of Northeastern New York (Lions Eye Bank of Albany), and Lions Eye Bank of Oregon.

A listing of the Cornea Donor Study Investigator Group, including clinical site investigators, eye bank staff, coordinating center staff, specular microscopy reading center staff, and committees, has been previously published online. The following Cornea Donor Study Publications Committee members independently reviewed and approved the manuscript for submission: Jonathan I. Macy, MD; Christopher J. Rapuano, MD; and Patricia W. Smith, MD.

The authors state that they have no relevant conflicts of interest to report.

Received September 06, 2012

Accepted October 25, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.