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J. B. Taylor, B. H. Jeng; Corneal Transplantation Performed by Residents at a County Hospital. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1127.
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To review the outcomes of penetrating keratoplasty (PKP) and complex keratoplasty, including deep anterior lamellar keratoplasty (DALK) and descemet stripping automated endothelial keratoplasty (DSAEK) performed by residents at a county hospital.
A retrospective chart review was performed of all patients undergoing various types of corneal transplantation surgery performed by residents under the direct supervision of a cornea specialist between April 2005 and November 2009.
During the study period, 21 eyes of 21 patients underwent various types of corneal transplantation surgery including 16 PKP’s, 3 DALKs and 2 DSAEKs. One eye underwent 2 separate procedures: a total lamellar keratoplasty followed by a PKP for Terrien marginal degeneration. The average age of the patients was 54 years (range 20-93). The average length of follow up was 16 months. The most common indication for transplantation was pseudophakic bullous keratopathy, followed by failed previous graft. There was one (4.5%) intraoperative complication consisting of an eccentric donor trephination rendering the donor tissue unusable, which required rescheduling of the surgery. Immediate post-operative complications included 2 eyes with wound leaks that required re-suturing. Late post-operative complications included one eye with a suture abscess, two eyes with peripheral anterior synechiae, and one eye which developed glaucoma requiring tube shunt surgery. Two PKP’s ultimately failed, but the remaining 19 grafts were clear at last follow-up. Seventeen of the 21 eyes had improved visual acuity compared to pre-operatively, with 2 eyes maintaining the same level of vision, and 2 eyes having worse vision.
Corneal transplantation, including complex procedures such as DSAEK and DALK can be performed successfully by ophthalmology residents with favorable anatomical and visual outcomes.
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