Corneal graft surgery: A monocentric long-term analysis

Abstract

Purpose: To investigate indications, outcomes and changes in clinical patterns of keratoplasty surgery in a Spanish tertiary eye center. Setting: Vissum Instituto Oftalmológico, Alicante, Spain. Methods: A retrospective review was performed on clinical records of patients that underwent any kind of corneal transplant from 2001 to 2017 in the study center. Inclusion criteria involved the presence of detailed preoperative examination, surgical report and at least 12 months follow-up after the surgery. A statistical analysis was performed on the indications for keratoplasty, survival rates, type of graft failures, and visual outcomes. Results: A total of 907 keratoplasties procedures were identified. About 432 penetrating keratoplasty (PK), 148 deep anterior lamellar keratoplasty (DALK), and 134 endothelial keratoplasty (EK) met the inclusion criteria. Cumulative survival rate ranged from 94% to 69% in a 1-year period and from 85% to 45% in a 5-years period according to the different graft types. The main cause for failure was immunological rejection for PK, surface diseases for DALK and primary graft failure for EK. Postoperative visual function improved for all the surgical techniques. Conclusion: Corneal transplant is a challenging surgery still complicated by a relevant risk of failure. Our study offers a useful opinion of the current trends on keratoplasty in our country, where the outcomes of the grafts differ considerably in relation to the indications and the different surgical techniques, with lamellar procedures that showed higher rates of success and better visual outcomes than full-thickness grafts.

Corneal transplantation activity in Catalonia, Spain, from 2011 to 2018: Evolution of indications and surgical techniques

“…Moreover, in Italy, an increasing trend of posterior lamellar techniques was found between 2002 and 2008 whereas in our area it happened after 2013 [13]. Other authors have investigated the keratoplasty activity in different centers in Spain [36,37]. As in their conclusions, we found than PKP was still the most prevalent technique used globally during the period of study despite the advantages described in literature of EK over PKP [21,23,25].…”

Editorial: Regenerative surgery of the cornea

“…Anatomical failure in PKP is estimated to be between 20 and 30% at 5 years, in DALK about 20% and in DMEK, DSEK from 2 to 5%, with the main reasons being, primary graft failure, immunological rejection followed by primary graft failure, late endothelial failure, and negative impact of comorbidities such as glaucoma, ocular surface disease and reoccurrence of the original disease. The results were validated in Spain by a monocentrical study which confirmed that these issues were affecting also the outcomes of a high-volume center ( 2 ) and a general review of the topic published recently ( 3 ) proved that this is a worldwide problem. Functional outcomes failures happen frequently due to refractive reasons, inadequate corneal transparency, being estimated that in PRK and DALK over 30% of the successful anatomical cases end in best corrected visual acuity of < 0.4 ( 4 ).…”

Risk and Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Infection on Corneal Transplantation: A Case–Control Study

“…For patients who received a full-thickness transplant, the most common complication was graft failure in 10.7% of cases, which is similar to 6% to 31% reported by others, depending on the optical or therapeutic indications for transplantation. 54,55 Patients with anterior lamellar grafts had a failure rate of 11% (compared with 0%–7.0%) 56,57 ; however, this could be related to our relatively small sample. The rate of endothelial graft detachment was 12.1% for DSAEK and 31.6% for DMEK cases, which is similar to the previously reported incidences of 1.3% to 23.0% 58,59 and 6.8 to 40.0%, 60–62 respectively.…”