Elsevier

Ophthalmology

Volume 119, Issue 7, July 2012, Pages 1311-1319
Ophthalmology

Original article
Indications, Outcomes, and Risk Factors for Failure in Tectonic Keratoplasty

Presented at: Asia Cornea Society Meeting, December 2010, Kyoto, Japan.
https://doi.org/10.1016/j.ophtha.2012.01.021Get rights and content

Purpose

Outcomes of corneal transplantation for tectonic indications and risk factors for (tectonic and physiologic) graft failure.

Participants

Consecutive patients who underwent keratoplasty for tectonic indications at the Singapore National Eye Centre (SNEC) between January 1, 1991, and December 1, 2009.

Methods

Clinical data and donor and recipient characteristics were recorded and analyzed from subjects in the prospective Singapore Corneal Transplant Study.

Main Outcome Measures

(1) Tectonic (anatomic) failure defined as recurrence of corneal melt threatening tectonic integrity and requiring additional corneal grafting within 3 months of the primary procedure. (2) Physiologic failure defined as irreversible change in graft clarity preventing recovery in useful vision in grafts initially clear 2 weeks postoperatively.

Results

The mean age of the study cohort (n = 362, 193 male and 169 female subjects) was 51.5±20.2 years, with a mean follow-up of 25.8±18.7 months. Patients underwent penetrating keratoplasty (PK) (n = 142, 39.2%), anterior lamellar keratoplasty (ALK) (n = 127, 35.1%), or a peripheral corneoscleral patch graft (n = 93, 25.7%) most commonly for inflammation (n = 68, 18.8%), trauma (n = 66, 18.2%), or infection (n = 66, 18.2%). Risk factors for tectonic failure (18/362 eyes, 5.0%) were severe lid disease (odds ratio [OR], 6.1; 95% confidence interval [CI], 1.7–22.1; P = 0.006), central ALK (OR, 7.5; 95% CI, 1.8–32.4; P = 0.007), and peripheral grafts (OR, 5.7; 95% CI, 1.1–28.3; P = 0.035). Among anatomically successful central grafts (n = 223), the mean physiological graft survival was 96 months (95% CI, 83–110); Kaplan–Meier probabilities for survival at 10 years were 66.8% for ALK and 44.2% for PK. Active corneal inflammation (hazard ratio [HR], 2.5; 95% CI, 1.4–4.4; P = 0.003) and larger donor and recipient graft sizes of ≥9 mm (HR, 17.9; 95% CI, 2.3–140.3; P = 0.006) were risk factors for physiologic graft failure in anatomically successful eyes with central tectonic grafts.

Conclusions

Patients with lid disease, central ALK, and peripheral grafts were at higher risk of anatomic failure. For anatomically successful cases with central tectonic grafts, active corneal inflammation and donor size ≥9 mm were risk factors for physiologic failure. In these cases, our results suggest that ALK had better physiologic graft survival outcomes than PK.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Materials and Methods

We conducted a retrospective, nested cohort study of consecutive patients who underwent keratoplasty for tectonic indications at the Singapore National Eye Centre between January 1, 1991, and December 1, 2009. All demographic data and clinical data were obtained from the ongoing cohort of the Singapore Corneal Transplant Study (SCTS), an audited longitudinal prospective study that contains preoperative, intraoperative, and yearly postoperative follow-up clinical data on all corneal transplants

Study Cohort

There were 362 patients (362 eyes) who had tectonic keratoplasty performed during the study period. The demographics of our study cohort and the indications for tectonic surgery are described in Table 1. Most grafts were central (n = 269, 74.3%). The mean diameter of the central grafts was 6.5 to 10.5 (mean 7.5±2.4) mm, and the grafts were oversized by 0.5 to 2.0 (mean 1.6±0.6) mm. Most PK grafts were ≥9 mm (n = 63, 44.4%), and most ALK grafts were 6.5–7.0 mm (n = 60, 48%). The common surgical

Discussion

In this study of tectonic corneal grafts, we studied 2 main outcomes: tectonic and physiologic graft success. First, we found an anatomic success rate of 95.0% in eyes that had undergone tectonic corneal grafts. Patients who received central ALK or peripheral corneal grafts were more likely to require a repeated corneal graft within 3 months from the primary procedure, after adjusting for potential confounders. Patients with severe lid disease were also 6 times more likely to experience

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Manuscript no. 2011-1579.

Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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