Claire Monnereau1, Marieke Bruinsma2, Lisanne Ham2, Lamis Baydoun1, Silke Oellerich3, Gerrit R J Melles4. 1. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands. 2. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, Netherlands. 3. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands. 4. Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, Netherlands. Electronic address: research@niios.com.
Abstract
PURPOSE: To report early, specific changes in donor endothelial cell morphology as a predictor of an upcoming allograft rejection after Descemet membrane endothelial keratoplasty (DMEK). DESIGN: Retrospective, observational case series. METHODS: Out of a cohort of 500 eyes that underwent DMEK at a tertiary referral center, 7 eyes developed typical clinical signs of an allograft rejection. Specular microscopy images before, during, and after the rejection episode were analyzed and compared with a case-control group of 49 asymptomatic DMEK eyes that matched baseline characteristics of the rejection group. Endothelial cell morphology was evaluated by subjective scoring (range 1-5) in a masked fashion as well as by an objective comparison of endothelial cell density, cell size, coefficient of variation, and hexagonality in rejection vs control eyes. RESULTS: Subjective scores (median) were higher before and after rejection (2.5 and 5, respectively) than in the DMEK control group (2.0 and 2.5, respectively) at comparable time points (P = .0230 and P = .0005, respectively). Endothelial cell density also differed before (P = .0106) and after rejection (P = .0240), while hexagonality differed before (P = .0499) but not after rejection (P = .1767). CONCLUSION: Our study suggests that allograft rejection may not be an acute event, but rather a slow-onset immune response. Early, specific changes in endothelial cell morphology were found to "announce" an upcoming allograft rejection. If so, monitoring donor endothelium after DMEK or other forms of keratoplasty may be used to anticipate a rejection episode and/or to prevent an allograft rejection from clinically manifesting itself.
PURPOSE: To report early, specific changes in donor endothelial cell morphology as a predictor of an upcoming allograft rejection after Descemet membrane endothelial keratoplasty (DMEK). DESIGN: Retrospective, observational case series. METHODS: Out of a cohort of 500 eyes that underwent DMEK at a tertiary referral center, 7 eyes developed typical clinical signs of an allograft rejection. Specular microscopy images before, during, and after the rejection episode were analyzed and compared with a case-control group of 49 asymptomatic DMEK eyes that matched baseline characteristics of the rejection group. Endothelial cell morphology was evaluated by subjective scoring (range 1-5) in a masked fashion as well as by an objective comparison of endothelial cell density, cell size, coefficient of variation, and hexagonality in rejection vs control eyes. RESULTS: Subjective scores (median) were higher before and after rejection (2.5 and 5, respectively) than in the DMEK control group (2.0 and 2.5, respectively) at comparable time points (P = .0230 and P = .0005, respectively). Endothelial cell density also differed before (P = .0106) and after rejection (P = .0240), while hexagonality differed before (P = .0499) but not after rejection (P = .1767). CONCLUSION: Our study suggests that allograft rejection may not be an acute event, but rather a slow-onset immune response. Early, specific changes in endothelial cell morphology were found to "announce" an upcoming allograft rejection. If so, monitoring donor endothelium after DMEK or other forms of keratoplasty may be used to anticipate a rejection episode and/or to prevent an allograft rejection from clinically manifesting itself.
Authors: Chaitanya Kolluru; Beth A Benetz; Naomi Joseph; Harry J Menegay; Jonathan H Lass; David Wilson Journal: Proc SPIE Int Soc Opt Eng Date: 2019-03-13
Authors: Naomi Joseph; Chaitanya Kolluru; Beth A M Benetz; Harry J Menegay; Jonathan H Lass; David L Wilson Journal: J Med Imaging (Bellingham) Date: 2020-02-14
Authors: Mohamed Abou Shousha; Sonia H Yoo; Mohamed S Sayed; Sean Edelstein; Matthew Council; Ravi S Shah; Joshua Abernathy; Zachary Schmitz; Patrick Stuart; Rocio Bentivegna; Maria P Fernandez; Christopher Smith; Xiaotang Yin; George J Harocopos; Sander R Dubovy; William J Feuer; Jianhua Wang; Victor L Perez Journal: Am J Ophthalmol Date: 2017-03-02 Impact factor: 5.258