Corneal transplantation at Tenwek Hospital, Kenya, East Africa: Analysis of outcomes and associated patient socioeconomic characteristics

Chen, Michael C.; Kunselman, Allen R.; Stetter, Christy; Hannush, Sadeer B.; Roberts, Benjamin W.

doi:10.1371/journal.pone.0187026

Cited by 8 publications

(8 citation statements)

References 22 publications

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“…This was expected as the symptom of blurred vision was previously cited as the chief presenting complaint amongst KC patients in studies conducted in Kenya. 9,10 However, Doreen et al 7 reported that the majority of patients in their study in Ghana complained of itching as the chief complaint. In this study, it could be that since patients presented when the KC was at an advanced stage with significant vision reduction, allergic complaints were less debilitating and hence of less concern as compared to reduced vision.…”

Section: Discussionmentioning

confidence: 90%

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<p>Visual Acuity and Refractive Error Improvement in Keratoconic Patients: A Low-Income Context Management Perspective</p>

Yego

Moodley

2020

OPTO

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Introduction: Visual acuity (VA) and refractive error (RE) remain important parameters in the management of keratoconic (KC) patients. Despite rapid amelioration in capacity of diagnostic equipment, these remain inaccessible to the majority of practitioners in lowincome countries. Notwithstanding limitations, practitioners are expected to utilize existing resources to satisfactorily manage their increasing numbers of keratoconic patients. Purpose: To determine the changes in visual acuity and refractive errors with diagnostic and management options available in low-income contexts. Methods: A descriptive, retrospective chart analysis of medical records dating back 5 years was employed in this study. Records of patients prescribed with corneal rigid gas permeable (RGP) and scleral lenses were analyzed. Data on age, gender, stage of keratoconus, pre-, and post-visual acuities and refractive errors, mode of correction and lens parameters were evaluated. Results: A total of 124 medical records were analyzed. Males comprised 58.9% and females 41.1% of the total sample, with a mean age 20.86 ± 9.50 years. The mean unaided VA in logMAR notation was 1.0±0.19, while corrected VA was 0.18±0.17. There was a significant improvement (p=0.001) in VA with corneal RGP contact lenses (mean 0.19±0.17) as compared to unaided VA (mean 1.29±0.20). Scleral lens VA also improved from a median of 1.06 to −0.01 logMAR; p=0.001. The mean RE before RGP contact lens fitting was −9.43 ±2.37 diopters (D) which improved to −0.41±0.78D. RE reduced significantly (p=0.001) after fitting with both corneal RGP lenses (from a mean of −9.80±4.46D to −0.45±0.80D) and scleral lenses (from a median of −8.00D to −0.02D). Conclusion: Significantly improved visual acuity and refractive error status were achieved with all KC patients. Despite the diagnostic equipment and contact lenses design limitations, practitioners in low-income contexts can fit the relatively more affordable corneal RGP lenses to positively impact the daily living experiences of their KC patients.

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Section: Discussionmentioning

confidence: 90%

“…A single facility-based study that analyzed the characteristics of 254 KC cases reported children as young as 6 years-old presenting with clinical signs. 9 Further, Chen et al 10 reported KC as the leading cause of corneal transplantation and other surgical interventions in Kenya.…”

Section: Introductionmentioning

confidence: 99%

<p>Visual Acuity and Refractive Error Improvement in Keratoconic Patients: A Low-Income Context Management Perspective</p>

Yego

Moodley

2020

OPTO

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“…The authors hypothesize that this finding may be related to poor patient compliance in the former group. 41…”

Section: Discussionmentioning

confidence: 99%

Demographic and Socioeconomic Determinants of Penetrating Keratoplasty Outcomes

Shalaby

Shukla

Shiuey

et al. 2022

Cornea

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Purpose:The aim of this study was to determine possible associations between demographic and socioeconomic factors and graft survival after penetrating keratoplasty (PK).Methods:This study was a retrospective chart review of patients undergoing PK at a tertiary-care corneal practice at Wills Eye Hospital between May 1, 2007, and September 1, 2018. The first PK of the first eye was included. The primary outcome measure was graft failure, defined as irreversible and visually significant graft edema, haze, or scarring. Demographic and socioeconomic factors included yearly average adjusted gross income (AGI) based on residential zip code, age, sex, and race. Two income groups were created: 1) individuals from neighborhoods with the lowest 10% of AGI (N = 82, AGI=$32,100 ± 4000) and 2) the remaining 90% of individuals (N = 740, AGI=$86,900 ± 52,200). Logistic regression analysis was performed to identify factors predictive of graft prognosis.Results:The 822 patients (822 eyes) included had a mean age of 57.1 ± 22.1 years at the time of PK. Over an average of 4.2 ± 3.1 years of follow-up, graft failure occurred in 35.3%. Age, sex, and follow-up duration were comparable between income groups (all P > 0.05). Black race was disproportionately represented in the lower-income group (50.0% vs. 11.5%, P < 0.001). Multivariable analysis identified predictors of graft failure including residing in a lower-income neighborhood [hazard ratio (HR) = 2.27, 95% confidence interval (CI) = 1.24-4.19, P = 0.008], younger age (HR = 0.99, 95% CI = 0.98–1.00, P = 0.046), and Black race (HR = 1.63, 95% CI = 1.03–2.56, P = 0.035).Conclusions:Individuals with a lower income, younger age, and Black race may be more vulnerable to graft failure after PK. Further studies are warranted to identify reasons for these associations.

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“…Both patient age and preoperative diagnosis as independent factors, as well as with and without their interaction, were not statistically significant at the 0.05 level. This is likely because in the previously reported data, 11 of the 13 (84.6%) patients diagnosed with PBK were over 60 years of age; whereas, only 4 of the 26 (15.4%) patients diagnosed with corneal scar and 1 of the 78 (1.3%) patients diagnosed with keratoconus were over 60 years of age [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…Outcomes of PKP at Tenwek Hospital, a tertiary care mission hospital in a rural low-resource setting located approximately 240 kilometers (4 hours) west of Nairobi, were previously reported [ 4 ]. While this study reported a favorable rate of improvement in uncorrected visual acuity and a favorable one-year graft survival rate, a significant percentage of the patient population (33.9%) was lost to follow-up (LTFU) at one year.…”

Section: Introductionmentioning

confidence: 99%

Lost to follow-up: reasons and characteristics of patients undergoing corneal transplantation at Tenwek Hospital in Kenya, East Africa

Ikpoh¹,

Kunselman²,

Stetter³

et al. 2020

PAMJ

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Introduction corneal transplantation is a surgical procedure requiring consistent long-term follow-up to maximize the chance of graft survival. The purpose of this study was to explore patient characteristics and reasons for being lost to follow-up (LTFU). Methods a retrospective review of clinical records from January 2012 to October 2014 was conducted of patients who received corneal transplantation at Tenwek Hospital. At the time of chart review, all patients who provided a mobile phone number were contacted to answer a phone questionnaire. Logistic regression was used to assess the association of each patient characteristic, separately, with the outcome of LTFU. Results of the 118 patients that met inclusion criteria, 40 (33.9%) were considered LTFU by failing to follow up at Tenwek Hospital to at least one year postoperatively. The odds of LTFU for patients age 60 and older were 3.78 times that of those who were 18-59 (95% CI: 1.21-11.80]; p-value=0.02). The odds of LTFU for patients with a preoperative diagnosis of pseudophakic bullous keratopathy were 3.83 times that of those with a preoperative diagnosis of keratoconus (95% CI: [1.13-12.94]; p-value=0.03). Education level, employment status, distance from the hospital, and possession of a mobile contact number appeared marginally associated with follow-up status, though not statistically significant at the 0.05 significance level. Financial barriers were the most commonly cited reason for LTFU (42.4%, n=14). Conclusion certain reasons and patient characteristics may be associated with follow-up adherence. Identifying these factors may help providers identify patients who are at a higher risk of LTFU and influence providers in medical decision-making and system-based interventions when offering corneal transplantation.

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Corneal transplantation at Tenwek Hospital, Kenya, East Africa: Analysis of outcomes and associated patient socioeconomic characteristics

Cited by 8 publications

References 22 publications

<p>Visual Acuity and Refractive Error Improvement in Keratoconic Patients: A Low-Income Context Management Perspective</p>

<p>Visual Acuity and Refractive Error Improvement in Keratoconic Patients: A Low-Income Context Management Perspective</p>

Demographic and Socioeconomic Determinants of Penetrating Keratoplasty Outcomes

Lost to follow-up: reasons and characteristics of patients undergoing corneal transplantation at Tenwek Hospital in Kenya, East Africa

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