Differential Survival of Penetrating and Lamellar Transplants in Management of Failed Corneal Grafts

Aboshiha, Jonathan; Jones, Mark; Hopkinson, Cathy; Larkin, Frank

doi:10.1001/jamaophthalmol.2018.1515

Cited by 28 publications

(34 citation statements)

References 24 publications

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“…In the 26-year study period, a total of 1728 keratoplasty procedures were performed in Auckland and 18.3% of these were repeat keratoplasties. This is comparable to the proportion of regrafts performed in other large centres including the United Kingdom (21.1%), 21 Canada (17.1% 8 -21.5% 5 ), United States (10%-18% of all grafts 1 and 22.0% of PKs 3 ), Scotland (19.2%) 7 and Italy (17.4%). 12 As in previous NZNEB studies, keratoconus was identified as the most common indication for corneal transplantation in New Zealand, representing 34.5% to 45.9% per annum of all Auckland keratoplasty cases .…”

Section: Discussionsupporting

confidence: 72%

“…In the 26‐year study period, a total of 1728 keratoplasty procedures were performed in Auckland and 18.3% of these were repeat keratoplasties. This is comparable to the proportion of regrafts performed in other large centres including the United Kingdom (21.1%), Canada (17.1%‐21.5%), United States (10%‐18% of all grafts and 22.0% of PKs), Scotland (19.2%) and Italy (17.4%) …”

Section: Discussionsupporting

confidence: 71%

“…A meta‐analysis performed by Wang et al concluded that EK after failed PK had the potential advantage of reduced risk of rejection but did not confer significant advantage in graft survival or visual outcome. A more recent report from the UK graft registry reported that for FED and PBK, there was no difference in graft survival between the PK‐PK and PK‐EK groups . It would be useful to revisit this in the future, with larger numbers and longer follow‐up of secondary EKs, particularly as DMEK may become the preferred EK technique.…”

Section: Discussionmentioning

confidence: 99%

“…A more recent report from the UK graft registry reported that for FED and PBK, there was no difference in graft survival between the PK-PK and PK-EK groups. 21 It would be useful to revisit this in the future, with larger numbers and longer follow-up of secondary EKs, particularly as DMEK may become the preferred EK technique.…”

Section: Discussionmentioning

confidence: 99%

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Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure

Boyle

Niederer

et al. 2019

Clinical Exper Ophthalmology

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Importance In New Zealand, repeat keratoplasty has become the second leading indication for corneal transplantation. Background To report the indications, outcomes and survival of repeat keratoplasty and evaluate the risk factors for graft failure. Design Retrospective study in a public corneal service. Participants Two hundred nineteen patients undergoing 279 repeat keratoplasty procedures during 1991‐2017. Methods The New Zealand National Eye Bank prospectively collects data on all corneal transplants. This was utilized to identify patients undergoing repeat keratoplasty in Auckland. Clinical records were retrospectively reviewed. Main Outcome Measures Graft survival and visual outcome. Results The repeat keratoplasty technique was penetrating keratoplasty (PK) in 242 cases (86.7%) and endothelial keratoplasty in 37 (13.3%). The most common primary indication was keratoconus (46.6%). The most common indication for repeat keratoplasty was endothelial decompensation (37.6%). For PK performed as a repeat keratoplasty, the median survival in years was 12.0 for first, 3.5 for second and 2.3 for third repeat keratoplasty. Keratoconus had the longest graft survival (median 13.0 years). In surviving grafts, median visual acuity was 6/15 at 1 year and 6/12 at 2 years. On multivariate analysis, regraft number (P = .022), non‐European ethnicity (P = .007), concurrent surgical procedure (P < .0005), lower donor endothelial density (P = .028), previous glaucoma surgery (P < .0005), postoperative raised intraocular pressure (P = .001) and graft rejection (P = .032) were associated with keratoplasty failure. Conclusions and Relevance Repeat keratoplasty survival is affected by multiple interacting factors and prognosis worsens with each subsequent regraft. These results will help guide clinicians in addressing patients' individual risk factors when embarking on repeat corneal transplant surgery.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure

Boyle

Niederer

et al. 2019

Clinical Exper Ophthalmology

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“…Outcome statistics from the past 5 years confirm that retransplantation following failure of one or more corneal allografts to the same eye is associated with high-risk for graft loss regardless of the primary corneal disease. 7,11,15 Within the ACGR, average survival at 4 years for a first ipsilateral full-thickness transplant for the low immunological risk condition keratoconus was 95%. This reduced sequentially with subsequent grafts (second, 86%; third, 71%; fourth or subsequent, 56%).…”

Section: Repeat Transplantationmentioning

confidence: 99%

High-risk Corneal Transplantation: Recent Developments and Future Possibilities

et al. 2019

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HISTORICAL AND GLOBAL SIGNIFICANCE OF CORNEAL TRANSPLANTATION AND FACTORS ASSOCIATED WITH HIGH IMMUNOLOGICAL RISK The landmark report by Eduard Zirm in 1905 of a successful full-thickness corneal transplant in a 45-year-old farm laborer with lime burn preceded, by several decades, the subsequent successes of vascularized organ transplants. 1,2 Following the introduction of topical corticosteroid therapies in the 1950s, corneal transplantation (keratoplasty) has become established as the primary sight-restoring procedure for corneal blindness in developed and developing countries. 3 Furthermore, while partial-thickness (lamellar) keratoplasty has now become the preferred transplant procedure for many corneal disorders, 4 fullthickness allograft remains the most frequently utilized treatment worldwide for corneal conditions associated with significant stromal opacity or vascularization such as bacterial, fungal, or viral infections; severe atopic disorders; ocular trauma and prior graft loss. Corneal opacity Review Abstract. Human corneal transplantation (keratoplasty) is typically considered to have superior short-and long-term outcomes and lower requirement for immunosuppression compared to solid organ transplants because of the inherent immune privilege and tolerogenic mechanisms associated with the anterior segment of the eye. However, in a substantial proportion of corneal transplants, the rates of acute rejection and/or graft failure are comparable to or greater than those of the commonly transplanted solid organs. Critically, while registry data and observational studies have helped to identify factors that are associated with increased risk of corneal transplant failure, the extent to which these risk factors operate through enhancing immune-mediated rejection is less clear. In this overview, we summarize a range of important recent clinical and basic insights related to high-risk corneal transplantation, the factors associated with graft failure, and the immunological basis of corneal allograft rejection. We highlight critical research areas from which continued progress is likely to drive improvements in the long-term survival of high-risk corneal transplants. These include further development and clinical testing of predictive risk scores and assays; greater use of multicenter clinical trials to optimize immunosuppressive therapy in high-risk recipients and robust clinical translation of novel, mechanistically-targeted immunomodulatory and regenerative therapies that are emerging from basic science laboratories. We also emphasize the relative lack of knowledge regarding transplant outcomes for infection-related corneal diseases that are common in the developing world and the potential for greater cross-pollination and synergy between corneal and solid organ transplant research communities.

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Introduction: Current Status of Modern Corneal Transplantation—Success, Failures and Turning Points

Alió,

Wróbel-Dudzińska,

Żarnowski

2023

Essentials in Ophthalmology

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Differential Survival of Penetrating and Lamellar Transplants in Management of Failed Corneal Grafts

Cited by 28 publications

References 24 publications

Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure

Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure

High-risk Corneal Transplantation: Recent Developments and Future Possibilities

Introduction: Current Status of Modern Corneal Transplantation—Success, Failures and Turning Points

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