TY - JOUR
T1 - In Vivo Characteristics of Corneal Endothelium/Descemet Membrane Complex for the Diagnosis of Corneal Graft Rejection
AU - Abou Shousha, Mohamed
AU - Yoo, Sonia H.
AU - Sayed, Mohamed S.
AU - Edelstein, Sean
AU - Council, Matthew
AU - Shah, Ravi S.
AU - Abernathy, Joshua
AU - Schmitz, Zachary
AU - Stuart, Patrick
AU - Bentivegna, Rocio
AU - Fernandez, Maria P.
AU - Smith, Christopher
AU - Yin, Xiaotang
AU - Harocopos, George J.
AU - Dubovy, Sander R.
AU - Feuer, William J.
AU - Wang, Jianhua
AU - Perez, Victor L.
N1 - Funding Information:
Funding/Support: This study was supported by a National Eye Institute (NEI), Bethesda, Maryland K23 award (K23EY026118), NEI core center grant to the University of Miami (P30 EY014801), Research to Prevent Blindness (RPB), New York, New York, and the American Society of Cataract and Refractive Surgery (ASCRS) Foundation, Fairfax, Virginia. The funding organizations had no role in the design or conduct of this research. Financial Disclosures: Mohamed Abou Shousha, Sonia H. Yoo, Jianhua Wang, and Victor L. Perez: United States Non-Provisional Patent Application (Application No.: 14/247903); patent is owned by University of Miami. Sonia H. Yoo is a consultant of Alcon, Allergan, Carl Zeiss Meditec, Bioptigen, Bausch and Lomb, and Transcend Medical, and has grants from AMO and Avedro. Victor L. Perez is a consultant of Alcon Ltd. The following authors have no financial disclosures: Mohamed S. Sayed, Sean Edelstein, Matthew Council, Ravi S. Shah, Joshua Abernathy, Zachary Schmitz, Patrick Stuart, Rocio Bentivegna, Maria P. Fernandez, Christopher Smith, Xiaotang Yin, George J. Harocopos, Sander R. Dubovy, and William J. Feuer. All authors attest that they meet the current ICMJE criteria for authorship.
Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2017/6/1
Y1 - 2017/6/1
N2 - Purpose To evaluate the utility of endothelial/Descemet membrane complex (En/DM) characteristics in diagnosing corneal graft rejection. Design Diagnostic reliability study. Methods One hundred thirty-nine eyes (96 corneal grafts post penetrating keratoplasty or Descemet stripping automated endothelial keratoplasty: 40 clear, 23 actively rejecting, 24 rejected, and 9 nonimmunologic failed grafts; along with 43 age-matched control eyes) were imaged using high-definition optical coherence tomography. Images were used to describe En/DM and measure central corneal thickness (CCT) and central En/DM thickness (DMT). En/DM rejection index (DRI) was computed to detect the relative En/DM thickening to the entire cornea. Results In actively rejecting grafts, DMT and DRI were significantly greater than controls and clear grafts (28, 17, and 17 μm and 1.5, 1 and 1, respectively; P < .001). Rejected grafts had the highest DMT and DRI compared to all groups (59 μm and 2.1; P < .001). DMT and DRI showed excellent accuracy, significantly better than that of CCT, in differentiating actively rejecting from clear grafts (100% and 96% sensitivity; 92.5% and 92.5% specificity), actively rejecting from rejected grafts (88% and 83% sensitivity; 91% and 83% specificity), and nonimmunologic failed from rejected grafts (100% and 100% sensitivity; 88% and 100% specificity). DMT correlated significantly with rejection severity (P < .001). Conclusions In corneal grafts, in vivo relative thickening of the En/DM is diagnostic of graft rejection as measured by DMT and DRI. These indices have excellent accuracy, sensitivity, and specificity in detecting graft immunologic status, superior to CCT. DMT is a quantitative index that correlates accurately with the severity of rejection.
AB - Purpose To evaluate the utility of endothelial/Descemet membrane complex (En/DM) characteristics in diagnosing corneal graft rejection. Design Diagnostic reliability study. Methods One hundred thirty-nine eyes (96 corneal grafts post penetrating keratoplasty or Descemet stripping automated endothelial keratoplasty: 40 clear, 23 actively rejecting, 24 rejected, and 9 nonimmunologic failed grafts; along with 43 age-matched control eyes) were imaged using high-definition optical coherence tomography. Images were used to describe En/DM and measure central corneal thickness (CCT) and central En/DM thickness (DMT). En/DM rejection index (DRI) was computed to detect the relative En/DM thickening to the entire cornea. Results In actively rejecting grafts, DMT and DRI were significantly greater than controls and clear grafts (28, 17, and 17 μm and 1.5, 1 and 1, respectively; P < .001). Rejected grafts had the highest DMT and DRI compared to all groups (59 μm and 2.1; P < .001). DMT and DRI showed excellent accuracy, significantly better than that of CCT, in differentiating actively rejecting from clear grafts (100% and 96% sensitivity; 92.5% and 92.5% specificity), actively rejecting from rejected grafts (88% and 83% sensitivity; 91% and 83% specificity), and nonimmunologic failed from rejected grafts (100% and 100% sensitivity; 88% and 100% specificity). DMT correlated significantly with rejection severity (P < .001). Conclusions In corneal grafts, in vivo relative thickening of the En/DM is diagnostic of graft rejection as measured by DMT and DRI. These indices have excellent accuracy, sensitivity, and specificity in detecting graft immunologic status, superior to CCT. DMT is a quantitative index that correlates accurately with the severity of rejection.
UR - http://www.scopus.com/inward/record.url?scp=85017161320&partnerID=8YFLogxK
U2 - 10.1016/j.ajo.2017.02.026
DO - 10.1016/j.ajo.2017.02.026
M3 - Article
C2 - 28259779
AN - SCOPUS:85017161320
SN - 0002-9394
VL - 178
SP - 27
EP - 37
JO - American journal of ophthalmology
JF - American journal of ophthalmology
ER -