AI Article Synopsis
- The study assesses the effectiveness of measuring endothelial/Descemet membrane (En/DM) characteristics for diagnosing corneal graft rejection.
- Using high-definition optical coherence tomography, 139 eyes were imaged and analyzed for central and En/DM thickness, with a focus on the En/DM rejection index (DRI).
- Results showed that DMT and DRI were significantly higher in actively rejecting and rejected grafts compared to clear grafts, indicating that these measurements are more accurate than central corneal thickness in detecting graft rejection severity.
Article Abstract
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.
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|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5482272 | PMC |
| http://dx.doi.org/10.1016/j.ajo.2017.02.026 | DOI Listing |
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