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Am J Ophthalmol. 2016 Oct;170:133-142. doi: 10.1016/j.ajo.2016.07.024. Epub 2016 Aug 4.

Changing Practice Patterns and Long-term Outcomes of Endothelial Versus Penetrating Keratoplasty: A Prospective Dutch Registry Study.

Author information

1
University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, Netherlands. Electronic address: mor.dickman@mumc.nl.
2
University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, Netherlands.
3
Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands.
4
Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
5
Euro Tissue Bank, Beverwijk, Netherlands.

Abstract

PURPOSE:

To compare graft survival, best-corrected visual acuity (BCVA), endothelial cell density (ECD), and refraction following penetrating keratoplasty (PK) vs endothelial keratoplasty (EK) for Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK).

DESIGN:

Nonrandomized treatment comparison with national registry data.

METHODS:

All consecutive patients undergoing first keratoplasty for FED and PBK between 1998 and 2014 were analyzed, with a maximum follow-up of 5 years (mean ± SD follow-up 39 ± 20 months, range 0-60 months). Graft survival was analyzed using Kaplan-Meier survival curves and Cox regression analysis. BCVA, ECD, and refractive error were compared using linear mixed models. Main outcome measures were graft survival, BCVA, refraction, and ECD.

RESULTS:

A total of 5115 keratoplasties (PK = 2390; EK = 2725) were identified. Two-year graft survival following EK was lower compared with PK (94.5% vs 96.3%, HR = 1.56, P = .001). Five-year survival was comparable for EK and PK (93.4% vs 89.7%, HR = 0.89, P = .261). EK graft survival improved significantly over time while remaining stable for PK. One-year BCVA was better following EK vs PK (0.34 vs 0.47 logMAR, P < .001). Astigmatism was lower 1 year after EK vs PK (-1.69 vs -3.52 D, P < .001). One-year ECD was lower after EK vs PK (1472 vs 1859 cells/mm2, P < .001). At 3 years, ECD did not differ between EK and PK.

CONCLUSIONS:

Long-term graft survival after EK and PK is high and comparable despite lower short-term survival for EK. EK graft survival improved over time, suggesting a learning curve. EK results in better BCVA, lower astigmatism, and similar long-term ECD compared with PK for FED and PBK.

PMID:
27497603
DOI:
10.1016/j.ajo.2016.07.024
[Indexed for MEDLINE]

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