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Post Info TOPIC: Endothelium cell death in PK


Executive

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Date: Sat Dec 31 9:55 AM, 2005
Endothelium cell death in PK
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This reasearch was published recently in Cornea. It tells us about very long-term (10 -17 years) outcomes of corneal transplantation for keratoconus patients with the focus on the endothelial calls death after KC. It tells us that PK, or corneal graft, "kills" endothelial cells, whose number falls drastically. Well, this number falls down, but, fortunately, not to the critical level after which corneal oedema may happen for endothelial cells would not pump the liquid as efficiently. Generally speaking PK may cause endothelial instability in long term.
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Penetrating Keratoplasty for Keratoconus: Long-Term Results.

Cornea. 24(8):959-961, November 2005.
Zadok, David MD *; Schwarts, Shula MD *; Marcovich, Arie MD +; Barkana, Yaniv MD *; Morad, Yair MD *; Eting, Eva MD *; Avni, Isaac MD *

Abstract:
Purpose: To study central corneal endothelial cell density and morphology and corneal topography in transplanted corneas for keratoconus 10 to 17 years postoperatively.

Methods: Retrospective, noncomparative case series including all keratoconus patients who underwent penetrating keratoplasty by one surgeon, at the same center, between January 1986 and December 1994. Seventeen patients (22 eyes) met the criteria. Four patients (5 eyes) with unchanged visual acuity during the follow-up period did not agree to return for the last follow-up examination, 1 patient (1 eye) had graft failure, and 3 patients (4 eyes) were lost to follow-up. We reviewed the charts of 9 patients (12 eyes), and collected data including manifest refraction, best corrected visual acuity (BCVA), endothelial cell density, cell morphology, and corneal topography.

Results: The mean follow-up period for all eyes evaluated was 13.3 +/- 2.4 years (range 10-17 years). At the last follow-up, 91.7% of eyes achieved BCVA of 20/40 or better, and mean endothelial cell density was 695 +/- 113.6 cells/mm2. Pleomorphism was detected in 5 eyes. Keratoconus pattern, by corneal topography, was not detected in any eye at the final examination.

Conclusions: Endothelial cell count 10-17 years post-PKP for keratoconus is very low with pleomorphism and viable grafts, indicating continued endothelial instability.

(C) 2005 Lippincott Williams & Wilkins, Inc.




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yarsky


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Date: Sat Dec 31 11:01 AM, 2005
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Its very important that anyone reading these results (We have been seeing similar reports for years now) too confront our respective doctors.
Get them to review the viability of PK and to answer you directly why it is still presented as the golden 96% final answer to KC.
Ask them to 'directly' tell us WHY chronic KCer's that are sitting on graft waiting lists are not FULLY INFORMED as to their alternatives.
If enough people are vocal then change will come about... its time for a shake-up!!!

Hari

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Date: Mon Jan 2 9:15 PM, 2006
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