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Nathan Lambert, Jennifer Rose-Nussbaumer, Winston Chamberlain; Keratoplasty Outcomes in Patients with Uveitis. Invest. Ophthalmol. Vis. Sci. 2018;59(9):1325.
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A retrospective observational study to analyze outcomes of patients with uveitis who underwent corneal transplantation to add to the limited data of outcomes reported in the literature.
We reviewed records of patients from the Casey Eye Institute (Portland, OR) with ICD-10 codes H20.X (unspecified iridocyclitis) and 363.2X (other and unspecified forms of chorioretinitis and retinochoroiditis, including pars planitis) that had also undergone keratoplasty between January 1, 2010 and November 1, 2017. Outcomes measured included reason for primary and secondary corneal transplant(s), graft survival time, cause of graft failure, occurrence and timing of glaucoma (tube or trabeculectomy) and retina (pars plana vitrectomy [PPV]) surgeries in relation to initial transplant. Statistical analysis was performed using 2-tailed Mann-Whitney U-test and Chi-squared analysis.
In the 14 identified patients, 26 primary corneal transplants were performed via penetrating keratoplasty (PKP)(n=16) or Descemet’s stripping automated endothelial keratoplasty (DSAEK)(n=10). Five patients experienced graft failure and required repeat transplants. Reasons for graft failure included endothelial failure (n=4), infection (n=3), graft failure with neovascularization (n=3), and persistent graft detachment (n=1). Mean survival time (months) of primary grafts and secondary grafts was 34.1 and 15.0, respectively (p=0.04). Graft survival time of primary DSAEK grafts was twice that of primary PKP grafts (46.1 vs 23.6, p=0.09), but secondary DSAEK grafts failed twice as quickly as secondary PKP grafts (11.7 vs 30.0, p=0.09). Of patients with a failed primary graft, 80% (4 of 5) underwent glaucoma surgery prior to or during initial transplant compared to 44% (4 of 9) of those with an unfailed primary graft (p=0.19). Additionally, 60% (3 of 5) of patients with a failed primary graft underwent PPV prior to or during initial transplant compared to 22% (2 of 9) of those with an unfailed primary graft (p=0.16).
Corneal transplants in patients with uveitis who undergo glaucoma or retina surgery may be at increased risk of failure. Primary DSAEK grafts may outlast primary PKP grafts in this population. Future clinical trials investigating interventions in patients with uveitis who undergo corneal transplantation require these preliminary observations.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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