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Endothelial cell changes as an indicator for upcoming allograft rejection following Descemet's membrane endothelial keratoplasty

Poster Details

First Author: I.Dapena SPAIN

Co Author(s):    L. Baydoun   C. Monnereau   M. Bruinsma   L. Ham   S. Oellerich   G. Melles

Abstract Details


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


Netherlands Institute for Innovative Ocular Surgery / Tertiary referral center.


Out of a cohort of 500 eyes that underwent DMEK at a tertiary referral center, seven eyes developed typical clinical signs of 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. Endothelial cell morphology was evaluated by subjective scoring [range 1 - 5] in a masked fashion as well as an objective comparison of endothelial cell density, cell size, coefficient of variance, and hexagonality in rejection versus control eyes.


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=0.0230 and P=0.0005, respectively). Endothelial cell density did differ before (P=0.0106) and after rejection (P=0.0024), while hexagonality did differ before (P=0.0499), but not after rejection (P=0.1767).


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. FINANCIAL INTEREST: One of more of the authors... receives consulting fees, retainer, or contract payments from a competing company

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