University Eye Hospital Freiburg, Germany.
Cornea. 2010 Oct;29(10):1113-7. doi: 10.1097/ICO.0b013e3181d21d07.
To present a novel interpretation of the biexponential nature of chronic endothelial cell loss after penetrating keratoplasty (PK). We hypothesize that the fast component of endothelial cell loss reflects the endothelial cells of graft origin. The slow component might just reflect cell loss of the recipient endothelium. We investigate herein whether this hypothesis is in line with long-term survival in bullous keratopathy (BK: almost no endothelium in the recipient bed) and keratoconus (KK: recipient bed with plenty of endothelium).
We reviewed endothelial graft failures in PK for BK (n = 88) and KK (n = 87). Patients with immune reactions or a history of glaucoma were excluded. We built a statistical model to predict graft failures from biexponential endothelial cell loss and compared this data to the actual outcomes.
After 15 years, the incidence of late endothelial failures was 8% in KK and 33% in BK. The 95% confidence intervals of the simulated outcomes corresponded completely to the actual outcomes during follow-up.
Our novel interpretation of the biexponential model is in line with long-term data of PK for BK and KK. Our findings highlight the importance of the recipient bed endothelial reservoir on the long-term prognosis in PK.
对穿透性角膜移植术后（PKP）慢性内皮细胞丧失的双指数性质提出新的解释。我们假设快速成分的内皮细胞丧失反映了移植物来源的内皮细胞。缓慢成分可能只是反映了受者内皮细胞的丧失。我们在此研究这一假设是否与大疱性角膜病变（BK：受者床几乎没有内皮细胞）和圆锥角膜（KK：有大量内皮细胞的受者床）的长期存活相符。
我们回顾了 BK（n=88）和 KK（n=87）的穿透性角膜移植内皮移植失败病例。排除有免疫反应或青光眼病史的患者。我们建立了一个统计模型，从双指数内皮细胞丧失预测移植物失败，并将这些数据与实际结果进行比较。
15 年后，KK 的晚期内皮功能障碍发生率为 8%，BK 为 33%。模拟结果的 95%置信区间在随访期间与实际结果完全吻合。
我们对双指数模型的新解释与 BK 和 KK 的 PKP 长期数据相符。我们的发现强调了受者床内皮细胞储备对 PKP 长期预后的重要性。
