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Ophthalmology. 2014 May;121(5):979-87. doi: 10.1016/j.ophtha.2013.12.017. Epub 2014 Feb 1.

A comparison of lamellar and penetrating keratoplasty outcomes: a registry study.

Collaborators (912)

Aboud JD, Aboud ND, Achnad J, Adams A, Adamski M, Adler P, Agnello R, Albietz JM, Alexander R, Al-Horani G, Alkins, Allan B, Ambler J, Anderson IL, Anderson J, Anderson L, Anderson PF, Andersons V, Ang A, Anzelmi V, Apel AJ, Apel JV, Apiro P, Aralar A, Armstrong RJ, Arnold JJ, Asimakis P, Asten G, Astri M, Athanasiou C, Athanasiov P, Atkins TJ, Atkinson GA, Austin CW, Azar D, Bahemia AM, Baig SH, Bailey CP, Bailey MJ, Baker CH, Balachandran C, Ball M, Bambery SJ, Barila A, Barker NH, Barnes BJ, Barnes CJ, Barnett WJ, Barrett G, Bassili S, Beaumont P, Beckingsale P, Beltz I, Beltz J, Benecke P, Benjamin FA, Bennett C, Benson CJ, Billson FA, Binetter RG, Black D, Blane JP, Bolliger PA, Bonnelamb T, Booth F, Booth-Mason S, Boreham C, Borger JP, Bors FH, Bosky T, Both R, Bougher GJ, Boyce J, Bradshaw H, Brennan MH, Brian G, Briner AM, Brooks AM, Brown CJ, Brunckhorst A, Buckley CA, Bui C, Burgess FC, Burt PF, Burvill MJ, Buttery RG, Byrne JB, Cains SE, Cairns JD, Calthorpe M, Cameron R, Campanella G, Campbell DV, Campbell WG, Candy D, Cano DD, Carey TM, Carroll LA, Cassidy D, Chadha VB, Chai KC, Chaing M, Challinor CJ, Chan C, Chan DG, Chan E, Chan I, Chandra J, Chang A, Chapman PJ, Charalambous T, Charawanamuttu A, Charley N, Chau P, Chehade MA, Chelvanayagam D, Cheok FP, Cher I, Cherny M, Chester GH, Chi J, Chin D, Chiu DW, Ch'ng AC, Chow S, Chowdhury V, Chua SK, Clark B, Clemens I, Cockie P, Cohen PR, Cohn GS, Collie DM, Conaghan T, Confos N, Connell B, Conrad D, Constable IJ, Constantine M, Conway RM, Cooper PS, Cooper RL, Coote BD, Coote MA, Corbett D, Cornwell R, Coroneo M, Cosgrove JM, Coster DJ, Cottee LB, Craddock N, Cranstoun PD, Crawford BA, Crawford GJ, Crayford BB, Crock GW, Crompton JL, Cronin B, Cunningham F, Cutler B, Czigler B, Da Rin D, Dal-Pra ML, Dalton JA, Dang V, Daniel M, Daniell MD, Danks J, Davey JC, Davies GA, Davies IC, Davies J, Davies M, Davies P, Davies RP, Davis GJ, Davis H, Davis JL, De Vincentis F, De Wet M, Del Popplo S, Delahunty D, Delaney MR, Della N, Den BD, Denman DP, Dethlefs RF, Devereaux J, Diab D, Diamond J, Dickson D, Dinihan IJ, D'Mellow G, Dobinson JS, Don B, Donaldson C, Donaldson M, Donovan B, Dostal F, Douglas I, Downes C, Downie NA, Doyle S, D'Souza B, du Temple DJ, Duggan JM, Duke PS, Duncan M, Dunlop AA, Dunlop C, Dunlop IS, Durkin DT, Dyer JA, Dyson C, Economos AS, Elder JR, Ellis MF, English FP, English KP, English M, Ennos A, Eshun-Wilson T, Evans L, Farinelli AC, Farpour B, Farrah J, Favilla I, Favilla ML, Ferdinands M, Ferguson M, Fernando G, Field AJ, Finkelstein E, Finnigan S, Fitzsimons SR, Flaherty MP, Flanders M, Fleming PR, Fong LP, Foo KP, Forster TD, Foster AJ, Fraenkel G, Frame I, Francis D, Francis IC, Franks SS, Frauenfelder G, Frumar KD, Fullarton F, Galbraith JE, Galbraith JK, Game J, Gardner R, Gaston G, Gaulke S, Gehling NJ, Genge J, Gianarakis N, Gibbons N, Giblin ME, Gibson AG, Gibson AJ, Gibson BH, Giles M, Gillanders W, Gillies MC, Gillies WE, Gin M, Glasson WJ, Glastonbury J, Glastonbury JG, Gnanaharan P, Goddard SJ, Godfrey S, Goggin M, Golchin B, Goldberg I, Gole G, Golik F, Goodrich M, Gorji Z, Gormley P, Graham SL, Grant P, Greaves A, Greer DV, Gregor DJ, Gregory EM, Grice MJ, Griffith R, Griffits RK, Groeneveld E, Grover VK, Gullifer KP, Gupta A, Gutteridge I, Hagen E, Hall AJ, Hall DR, Hall J, Hall P, Hall R, Halley RM, Ham BK, Ham KB, Hammerton ME, Hand C, Handley DE, Hann J, Hansen C, Hardy-Smith P, Harkness MM, Harris A, Harrisberg BP, Harrison JD, Harrison MR, Hart DR, Hatfield E, Hauptman O, Haybittel M, Hayes PA, Haymet BT, Heery SE, Hefferan W, Heine DI, Heiner P, Heiner PC, Heinze JB, Henderson RG, Henderson T, Hennessy MP, Henry JG, Heron H, Heyworth PL, Hill GO, Hill J, Hills T, Hing SJ, Hipwell GC, Hirst LW, Ho RH, Hobbs I, Hodson T, Hogan P, Holden HR, Hollenbach E, Hollows FC, Homewood PA, Hoole GA, Horak A, Hornbrook JW, Hornsburgh BJ, Hornsby C, House PH, Howe E, Howes F, Howsam GN, Hughes PH, Hunter GT, Hunyor A, Hurley IW, Hutchinson B, Huynh T, Ikladios A, Ingham PN, Ioannides A, Irvine S, Isbell G, Jacobi L, Jamieson IW, Jaross N, Jefferies P, Jester MP, Johnson GW, Jones SA, Jordan AS, Kalliris A, Kappagoda MB, Karagiannis A, Karunaratne DM, Karunaratne N, Kaufman DV, Kearney RJ, Kearns M, Keldoulis T, Kelly AJ, Kelly GJ, Kenna J, Kennedy IH, Kennedy JE, Kent DG, Kent R, Kerdraon Y, Kevin JB, Khalil J, Khannah G, Khong C, Khurana K, Kim P, King AC, Kingston D, Kingston RA, Kirkwood RA, Kitchen D, Knight J, Knights A, Knox-Cartwright N, Koh LK, Kokak G, Kokkinakis J, Koniuszko GA, Kosmin A, Kumar NL, Kwong RN, La Nauze JH, Lai Kwon N, Lam CM, Lam GC, Lamb AM, Landers J, Landers JA, Lane MJ, Langford-Smith J, Lansdell BJ, Larkin PW, Latimer A, Latimer PA, Laureamo J, Law W, Lawless MA, Lawson DJ, Le Feuvre RJ, Le May M, Leber GL, Leckie TD, Lee A, Lee GA, Lee JH, Lee V, Leikin S, Lenton LM, Leow Z, Leppard SD, Leunig GA, Leunig I, Leverett M, Lewis NL, Liew S, Lillicrap GR, Lim Joon TH, Lim AS, Lim P, Lim R, Lindsay R, Lister J, Littlewood KR, Liu HA, Liubinas J, Livingstone EA, Lloyd D, Loane ME, Lockerbie SE, Lockie P, Loh R, Loibl KJ, Lones RI, Loughnan MS, Louw Z, Low C, Lowe DR, Maccheron LK, Macfarlane S, MacIntyre R, Macken PL, Mackey DA, Maclean H, MacRobert I, Madhok P, Mahendrarajah T, Maher M, Mahmood MI, Majzoub U, Malatt AE, Males J, Maloney P, Maloof A, Manku MS, Manning LM, Mantford J, Mantzioros N, Maragoudakis G, Markwick KC, Marshall J, Martin FJ, Martin PA, Marton S, Materne M, Matus M, McAlister JC, McAllan A, McAuliffe DJ, McCartney PJ, McClellan KA, McCluskey PJ, McCombe MF, McDermott ND, McDonald MA, McDonald RA, McGeorge PA, McGhee CN, McGovern RA, McGovern ST, McGree MD, McGuinness EF, McGuinness R, McGuinness T, McKay AL, McKay DL, McKay R, McKee H, McKinnies C, McKnight DG, McLennan M, McMonnies C, McNeil G, Meades KV, Meagher PJ, Medownick M, Mele EM, Mihahidis M, Miller G, Millett P, Mills RA, Mills W, Milverton EJ, Minogue FJ, Minogue MJ, Misra A, Mitchell L, Montgomery PR, Moo G, Moon ME, Moore CE, Moore DC, Moore F, Moore GG, Moore MC, Moran DJ, Morgan MW, Morgan WH, Moriarty AP, Morlet GC, Morlet K, Morlet N, Morrisey CD, Morton MR, Moshegov CN, Mountford J, Mulholland, Mulligan NB, Mulligan S, Munchenberg P, Munt PC, Murchland JB, Murphy C, Murrell I, Nagle FJ, Nallari L, Nanda U, Nardi W, Narita A, Nathan F, Newland H, Newman J, Newman M, Ng P, Nguyen D, Nicholls SG, Nicoll AM, Nixon GK, Noble JA, Noble M, North IM, Novakovic P, O'Hagan S, O'Neill D, O'Sullivan M, O'Brien DP, O'Callaghan GJ, Ochsenbein M, O'Connor C, O'Connor DM, O'Connor PA, O'Day J, O'Donnell BA, Offerman DM, O'Hagan S, Ohlrich JG, Ohlrich S, Okera K, Okera S, O'Leary BJ, O'Neill JC, Ong K, Ong T, Ooi L, Painter GT, Panchapakesan J, Parker RW, Patel A, Patel D, Patel M, Pater JB, Patrick RK, Paul RA, Pavy IG, Peachey G, Pearce B, Pellew JH, Perks KC, Perriam DJ, Perrin RL, Perry K, Peters J, Petsoglou C, Phakey V, Philips D, Phillips AJ, Phillips T, Philp B, Phipps S, Pieris A, Pigott LJ, Pilgrim B, Pittar MR, Pittar YA, Playfair TJ, Plowman L, Pluschke ME, Pluschke WE, Poon AC, Porter GT, Porter RG, Porter WT, Pradhan JS, Pyle JD, Pyne R, Quatermass ME, Qureshi SH, Radley A, Rait JL, Ramani V, Ramsay RJ, Rathod CB, Ratnalingham V, Rawson LR, Rawstron J, Reader S, Readshaw C, Readshaw GG, Rees I, Reich JA, Reich P, Renehan MJ, Renton R, Retsas CW, Rice N, Richardi J, Richards JC, Richardson P, Riddington LJ, Rigg RW, Rigney M, Roberts J, Roberts TV, Robertson B, Robertson IF, Robinson DI, Robinson LP, Robinson R, Robson M, Rodan BA, Roden D, Rodwell S, Roebuck M, Rogers CM, Rogers JA, Rose LV, Rose MJ, Rose P, Rosen B, Rosen PA, Rosenberg AM, Ross CA, Ross R, Ross SM, Rosser I, Roydhouse JD, Ruddell TJ, Rumbach OW, Runciman JC, Russel P, Russell LJ, Russell M, Saareste AG, Sack M, Sahetopy L, Samuel MV, Saunders BG, Saunders S, Saw, Scales WT, Scargill N, Scargill SW, Schiller GM, Schilt D, Scobie MA, Scott B, Seawright A, Sebban IA, Serdiuk A, Shanahan LF, Sharma AK, Sharma D, Sharota DT, Sheppard CL, Siebert S, Sigmont R, Silva M, Simon A, Simpson MB, Sindhu KA, Singh H, Singh IC, Singh P, Singh R, Skalicky SE, Slack A, Slade JH, Slade M, Slade MP, Smiles JJ, Smith G, Smith J, Smith JE, Smith RL, Snibson GR, Soicher E, Somerville G, Soong VW, Southgate D, Spiro HP, Spokes D, Spring TF, Springhall G, Squires M, Stanley M, Starling D, Starling DB, Stasiuk RM, Steer N, Steiner HE, Steiner M, Steiner MD, Stephensen D, Stern H, Stern W, Stevens P, Stewart AD, Stewart PA, Strachan G, Stubbs GM, Stuckey GC, Sullivan F, Sullivan FP, Sullivan LJ, Sultan M, Sumich PM, Sutton G, Sutton JE, Svoboda E, Talbot AW, Talbot W, Tamblyn DM, Tandon A, Tang KC, Tangas C, Tappin, Taranto B, Taylor A, Taylor C, Taylor GA, Taylor HR, Taylor L, Taylor RF, Tchen T, Teske SA, Tester MP, Theron A, Thomas CS, Thomas K, Thomas R, Thompson C, Thomson CW, Thomson GG, Thyer HW, Tibbs GJ, Tint NL, Todd B, Tole D, Tolmie N, Ton Y, Toohey MG, Townsend CL, Townsend R, Tregenza P, Treloar D, Treplin MC, Tridgell DE, Tsang B, Turnball M, Tye AA, Unger H, Vajpayee RB, Van Tricht V, Van Truong, Van ZF, Vandeleur KW Jr, Vandeleur KW Sr, Velez S, Vercoe G, Verma N, Vernon AC, Versace P, Vicary D, Violi C, Vojlay R, Von ZY, Vote B, Vu P, Waite S, Waldie MS, Walker A, Walker FA, Walker G, Walker N, Walker TD, Walland MJ, Walsh EM, Walsh MA, Warburton C, Ward WJ, Wards G, Watson SL, Watt B, Watts WH, Waugh ML, Webb A, Weber A, Wechsler AW, Weir P, Welch RT, Wenas HJ, Wenck B, Weng N, West R, West T, Westlake W, Westmore RN, Whaites MA, Whitehouse CA, Whitehouse GM, Whitford JD, Whitford RF, Whiting M, Whitney JR, Wicks LA, Wicks NS, Wiffen SJ, Willcocks N, Williams NB, Williams RD, Williams W, Willoughby JG, Wilson BG, Wilson L, Wilson RG, Wilson T, Win Law W, Windle PL, Wingate RJ, Wise GM, Wittles N, Wolfe RJ, Wong-See JJ, Woo HY, Wood RF, Woods SW, Workman DM, Worner CM, Worsnop DP, Worthley DA, Wunsh MR, Yates WH, Yellachich D, Yip J, You CS, Young SH, Yow CS, Yuen Z, Zamora.

Abstract

OBJECTIVES:

To investigate changing patterns of practice of keratoplasty in Australia, graft survival, visual outcomes, the influence of experience, and the surgeon learning curve for endothelial keratoplasty.

DESIGN:

Observational, prospective cohort study.

PARTICIPANTS:

From a long-standing national corneal transplantation register, 13 920 penetrating keratoplasties, 858 deep anterior lamellar keratoplasties (DALKs), and 2287 endokeratoplasties performed between January 1996 and February 2013 were identified.

METHODS:

Kaplan-Meier functions were used to assess graft survival and surgeon experience, the Pearson chi-square test was used to compare visual acuities, and linear regression was used to examine learning curves.

MAIN OUTCOME MEASURES:

Graft survival.

RESULTS:

The total number of corneal grafts performed annually is increasing steadily. More DALKs but fewer penetrating grafts are being performed for keratoconus, and more endokeratoplasties but fewer penetrating grafts are being performed for Fuchs' dystrophy and pseudophakic bullous keratopathy. In 2012, 1482 grafts were performed, compared with 955 in 2002, translating to a requirement for 264 extra corneal donors across the country in 2012. Comparing penetrating grafts and DALKs performed for keratoconus over the same era, both graft survival (P <0.001) and visual outcomes (P <0.001) were significantly better for penetrating grafts. Survival of endokeratoplasties performed for Fuchs' dystrophy or pseudophakic bullous keratopathy was poorer than survival of penetrating grafts for the same indications over the same era (P <0.001). Visual outcomes were significantly better for penetrating grafts than for endokeratoplasties performed for Fuchs' dystrophy (P <0.001), but endokeratoplasties achieved better visual outcomes than penetrating grafts for pseudophakic bullous keratopathy (P <0.001). Experienced surgeons (>100 registered keratoplasties) achieved significantly better survival of endokeratoplasties (P <0.001) than surgeons who had performed fewer grafts (<100 registered keratoplasties). In the hands of experienced, high-volume surgeons, endokeratoplasty failures occurred even after 100 grafts had been performed.

CONCLUSIONS:

More corneal transplants, especially DALKs and endokeratoplasties, are being performed in Australia than ever before. Survival of DALKs and endokeratoplasties is worse than the survival of penetrating grafts performed for the same indications over the same timeframe. Many endokeratoplasties fail early, but the evidence for a surgeon learning curve is unconvincing.

PMID:
24491643
DOI:
10.1016/j.ophtha.2013.12.017
[Indexed for MEDLINE]

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