Selahattin BALSAK, Dilbade YİLDİZ EKİNCİ

Keratoplasty indications and outcomes: The experience of a tertiary health center in Southeastern of Turkey

Aim: The study aims to report the indications of keratoplasty surgeries and our surgical outcomes performed in our hospital that provides tertiary health care.Materials and Methods: This retrospective study was conducted analyzing the files of the patients undergone keratoplasty for optical, therapeutic and tectonic purposes between 2014-2018. The patients' age, gender, indication for keratoplasty, preoperative and postoperative best-corrected visual acuity and surgical technique preferred, whether graft rejection developed or not during postoperative follow-ups, treatments administered to the patients developed rejection and follow-up periods were recorded.Results: The study included 200 eyes of 174 patients undergone keratoplasty. Of the eyes 180 (90%), 13 (6.5%) and 7 (3.5%) received corneal transplantation for optical purpose, for tectonic/therapeutic purpose and for cosmetic purpose respectively. The mean follow-up period was 21.7±6.2 months (range 6-48 months). Of the eyes 78 (39%), 40 (20%), 25 (12.5%), 19 (9.5%), 16 (8%), 11 (5.5%), and 9 (4.5%) were operated due to infectious/non-infectious corneal scar, pseudophakic/aphakic bullous keratopathy, graft failure/rejection, corneal dystrophy, keratoconus, keratitis/abscess and spontaneous corneal perforation respectively. Forty (20%) of the eyes developed allograft reaction. At the end of the study period, 50 (25%) eyes could not maintain graft transparency. The most common causes of inability to maintain graft transparency were endothelial failure and allograft reaction.Conclusion: Keratoplasty is an important and effective surgical method that increases visual acuity in blindness conditions caused by corneal diseases.

PDF

___

1. World Health Organisation. Prevention of blindness and visual impairment. 2015. Available at: http://www.who.int/blindness/causes/priority/en/index8.html access date 12.21.2015.
2. Matthaei M, Sandhaeger H, Hermel M, et al. Changing indications in penetrating keratoplasty: a systematic review of 34 years of global reporting. Transplantation 2017;101:1387–99.
3. Ayalew M, Tilahun Y, Holsclaw D, et al. Penetrating keratoplasty at a tertiary referral center in Ethiopia: indications and outcomes. Cornea 2017;36:665–8.
4. Sony P, Sharma N, Sen S, et al. Indications of penetrating keratoplasty in Northern India. Cornea 2005;24:989–91.
5. Lansingh VC. Trachoma. BMJ Clin Evid 2016;2016:706.
6. Whitcher JP, Srinivasan M, Upadhyay MP. Corneal blindness: a global perspective. Bull World Health Organ 2001;79:214-21.
7. Mathews PM, Lindsley K, Aldave AJ, et al. Etiology of global corneal blindness and current practices of corneal transplantation: a focused review. Cornea 2018;0:1–6.
8. Eye Bank Association of America. 2016 Eye Banking Statistical Report. Washington DC: Eye Bank Association of America; 2017.
9. Afshari NA, Pittard AB, Siddiqui A, et al. Clinical study of Fuchs' corneal endothelial dystrophy leading to penetrating keratoplasty: a 30-year experience. Arch Ophthalmol 2006;124:777–80.
10. Palamar Onay M, Egrilmez S, Civan BB, et al. Penetran keratoplasti sonrası hasta memnuniyeti. TJO 43;5:2013:348-51.
11. Bozkurt TK, Acar B, Kilavuzoglu AE, et al. An 11-Year review of keratoplasty in a tertiary referral center in Turkey: changing surgical techniques for similar indications. Eye & Contact Len 2016;0:1–7.
12. Genc O, Bulut N, Ort A. Keratoplasti ameliyatı endikasyonları ve ameliyat teknikleri. J Kartal TR 2012;23:61-4.
13. Dandona L, Ragu K, Janarthanan M, et al. Indications for penetrating keratoplasty in India. Indian J Ophthalmol 1997;45:163-8.
14. Dorrepaal SJ, Cao KY, Slomovic AR. Indications for penetrating keratoplasty in a tertiary referral centre in Canada, 1996-2004. Can J Ophthalmo 2007;42:244-50.
15. Zare M, Javadi MA, Einollahi B, et al. Changing indications and surgical techniques for corneal transplantation between 2004 and 2009 at a tertiary referral center. Middle East Afr J Ophthalmol 2012:19:323–9.
16. Pan Q, Li X, Gu Y. Indications and outcomes of penetrating keratoplasty in a tertiary hospital in the developing world. Clin Exp Ophthalmol 2012:40:232–8.
17. Park CY, Lee JK, Gore PK, et al. Keratoplasty in the United States A 10-Year Review from 2005 through 2014. Ophthalmology 2015:1-11.
18. Benson MD, Kurji K, Tseng C, et al. Analysis of penetrating keratoplasty in Northern Alberta, Canada, from 2000 to 2015. Can J Ophthalmol 53:568–73.
19. Nurozler AB, Akkaya ZY, Yildiz HE, ve ark. Penetran keratoplasti endikasyonları ve sonuçları. Turkiye Klinikleri J Ophthalmol 2009;18:85-91.
20. Al-Yousuf N, Mavrikakis I, Mavrikakis E, ve et al. Penetrating keratoplasty: indications over a 10 year period. Br J Ophthalmol 2004;88:998–1001.
21. Watson RM, Dawood S, Cao D, et al. Outcomes of pars plana vitrectomy in combination with penetrating keratoplasty. J Vitr Retinal Dis 2017;1:116-21.
22. WuDunn D, Alfonso E, Palmberg PF. Combined penetrating keratoplasty and trabeculectomy with mitomycin C. Ophthalmology 1999;106:396-400.
23. Laaser K, Bachmann BO, Horn FK, et al. Descemet membrane endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation: advanced triple procedure. Am J Ophthalmol 2012;154:47–55.
24. Shanbhag N, Cholera PP, Sahana N, et al. Evaluation of graft clarity post-penetrating keratoplasty. Int J Scient Study 2017;5:90-6.
25. Ono T, Ishiyama S, Hayashidera T, et al. Twelve-year follow-up of penetrating keratoplasty. Jpn J Ophthalmol 2017;61:131-6.
26. Dunn SP, Gal RL, Kollman C, et al. Corneal graft rejection ten years after penetrating keratoplasty in the cornea donor study. Cornea 2014;33:1003–9.