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Anthony F. Felipe, Kristin M. Hammersmith, Peter R. Laibson, Jennifer M. Nottage, Christopher J. Rapuano; Indications, Survival, And Visual Outcomes Of Corneal Transplants 20 Years Old Or Greater. Invest. Ophthalmol. Vis. Sci. 2011;52(14):359.
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To report the indications, survival, and visual outcome for corneal transplants that have remained clear 20 years or more.
Retrospective noncomparative case series. Subjects were identified by running a computer search of the electronic health records of all corneal transplant patients done by the Cornea Service of the Wills Eye Institute. Clear corneal grafts that are at least 20 years old were included in the study. Corneal transplants performed elsewhere were excluded.
60 eyes of 42 patients were intially identified. Penetrating keratoplasty (PK) was performed from 1965-1990 with a mean follow-up time of 25.8 ± 5.0 years (range, 20-45). Mean age of patients at the time of surgery was 38.7 ± 12.4 years-old (range, 9 to 71). The most common indications for corneal transplantation were keratoconus (80%) followed by Fuchs’ dystrophy (12%), HSV keratitis (7%), and failed graft (2%). Preoperative risk factors include deep stromal vessels in 5 eyes (8%), preexisting glaucoma in 1 (2%), and significant cataract in 3 (5%) necessitating combined lens extraction and PK. After 20 years or more, 34 eyes (57%) still had clear, compact grafts. 26 eyes (43%) had inferior graft-host ectasia beginning at 22 ± 4.84 years postoperatively (range, 13 to 32 years) and 3 eyes (5%) had subepithelial fibrosis. Mean corneal power was 46.03 ± 3.59 D (range, 36.2 to 51.5 D) and mean topographic astigmatism was 6.54 ± 3.79 D (range, 1.5 to 15.49 D) in 25 eyes (42%). Mean endothelial cell count by specular microscopy was 817 ± 280.41 cells/mm2 (range, 487 to 1699) in 16 (27%) out of 60 eyes. At last visit, mean best-correctd visual acuity (BCVA) was 0.25 ± 0.34 logMAR (20/35 Snellen equivalent) (range, 0 to 1.8) with a mean spherical equivalent of -4.12 ± 4.96 D and mean cylinder of 4.57 ± 2.38 D. 22 eyes (37%) had at least 1 episode of rejection which resolved with topical steroids. Other complications include glaucoma (13%), cataract progression (12%), HSV recurrence (8%) and suture abscess (2%).
Among the common indications for PK, keratoconus tends to have excellent graft survival and visual outcome. Development of ectasia and rejection episodes are problems to be encountered in grafts that have survived for more than 20 years.
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