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Diagnostic performance of the endothelial/Descemet’s membrane thickness vs endothelial cell density in the diagnosis of corneal graft rejection

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Session Details

Session Title: Cornea
Session Date/Time: Sunday 28/02/2016 | 08:30-11:00
Paper Time: 10:12
Venue: MC2 Room
First Author: : G.Kontadakis USA
Co Author(s): :    C. Smith   D. Kaitis   R. Bentivegna   S. Yoo   V. Perez   M. Abou Shousha

Abstract Details


To assess the diagnostic performance of the Endothelial/Descemet’s membrane thickness (EnDMT) as measured by the high resolution optical coherence tomography (HD-OCT) in the diagnosis of corneal graft rejection and compare it to that of endothelial cell density (ECD) and central corneal thickness (CCT).


Bascom Palmer Eye Institute and the Saint Louis University Eye Institute.


This prospective study includes 42 corneal grafts. Assessment included detailed history, clinical examination, automated assessment of the corneal endothelial layer with corneal confocal microscopy, and corneal imaging with HD-OCT. Blinded observers calculated manually CCT and EnDMT on HD-OCT images. Eyes were divided into two groups, rejected and clear grafts. CCT, EnDMT and ECD were compared between groups. Diagnostic performance of EnDMT for the diagnosis of graft rejection was evaluated using receiver operating characteristic (ROC) curves.


CCT and EnDMT showed statistically significant differences among groups. Clear grafts’ mean CCT was 525 μm (standard deviation [SD] 74) and mean EnDMT was 15μm (SD 3). Whereas, in the rejected grafts group, mean CCT was 809μm (SD 251) and mean EnDMT was 48 μm (SD 49, p<0.05 for corresponding comparisons, Mann-Whitney U test). On the other hand, no significant difference in ECD was found between the two groups. EnDMT showed better diagnostic accuracy than CCT (EnDMT area under the curve (AUC) was 0.93, p<0.001 and for CCT AUC was 0.81, p<0.001).


Endothelial/Descemet’s membrane thickness demonstrated excellent accuracy in the diagnosis of corneal graft rejection, which is significantly better than that of central corneal thickness and endothelial cell density.

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