gms | German Medical Science

28th International Congress of German Ophthalmic Surgeons (DOC)

11.06. - 13.06.2015, Leipzig

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Endothelial cell changes as an indicator for upcoming allograft rejection following Descemet membrane endothelial keratoplasty (DMEK) (K)

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  • Lamis Baydoun - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande
  • Claire Monnereau - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande
  • Marieke Bruinsma - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande
  • Lisanne Ham - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande
  • Silke Oellerich - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande
  • Gerrit Melles - Netherlands Institute for Innovative Ocular Surgery, Rotterdam, Niederlande

28. Internationaler Kongress der Deutschen Ophthalmochirurgen. Leipzig, 11.-13.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocWK 5.14

doi: 10.3205/15doc140, urn:nbn:de:0183-15doc1403

Published: June 9, 2015

© 2015 Baydoun et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Purpose: To report early, specific changes in donor endothelial cell (EC) morphology as a predictor of an upcoming allograft rejection after DMEK.

Methods: Out of 500 DMEK eyes, seven developed an allograft rejection. Specular microscopy images prior to, 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. EC morphology was evaluated by subjective scoring as well as an objective comparison of EC density, cell size, coefficient of variance, and hexagonality in rejection versus control eyes.

Results: Subjective scores were higher before and after rejection than in the DMEK control group. EC density differed before and after rejection, while hexagonality did differ before, but not after rejection.

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 manifest.