Keratoplasty for Keratoconus in Young Patients: Demographics, Clinical Features, and Post-transplant Outcomes

Wajnsztajn, Denise; Hopkinson, Cathy; Larkin, Frank; ophthalmologists, contributing

doi:10.1016/j.ajo.2021.02.003

Cited by 9 publications

(10 citation statements)

References 27 publications

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“…Recipients aged below 40 years were approximately 3 times more likely to develop graft rejection after repeat PK compared to recipients aged 40 years or older. Our finding was similar to results from previous studies that demonstrated a higher risk of corneal graft rejection in young recipients [ 8 , 14 , 23 – 25 ]. This phenomenon has been observed in other solid organ transplantations and could be explained by a more intense immune system found during adolescence and in young adults compared to those with advanced age [ 26 ].…”

Section: Discussionsupporting

confidence: 92%

Impact of gender mismatch on corneal graft rejection and rejection-related graft failure in repeat penetrating keratoplasty

et al. 2022

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Purpose To explore the impact of gender mismatch on corneal allograft rejection and rejection-related graft failure in patients with repeat penetrating keratoplasty (PK). Methods A retrospective cohort was conducted at Ramathibodi Hospital, Bangkok, Thailand. Patients with repeat PK and follow-up period of at least 6 months were recruited. Demographic data, pre-operative ocular findings and donor information were collected. Patients were divided into 2 groups according to gender mismatch between donor and recipient (male to female vs others). Survival analysis was performed using the Kaplan-Meier method. The association between risk factors and the outcomes of graft rejection and rejection-related graft failure were analyzed using Cox proportional hazards regression. Results Of 68 patients with repeat PK, 26 patients (38.2%) were gender mismatched. There was no difference in 3-year rejection-free survival and graft survival between patients with gender mismatch and others (p = 0.698 and p = 0.402, respectively). Younger recipients (< 40 years) showed a significantly higher rejection rate compared to older recipients (hazard ratio; HR = 3.14, 95% confidence interval; CI 1.15 to 8.58), while patients with multiple PK (> 2 times) were found to be significantly associated with higher rejection-related graft failure compared to patients with 2 times or less PK (HR = 2.72, 95% CI 1.03 to 7.21). After multivariate analysis, only younger recipients demonstrated a statistical significance on graft rejection (adjusted HR = 2.86, 95% CI 1.04 to 7.84). Conclusions Gender mismatch might not impact corneal graft rejection or rejection-related graft failure in patients with repeat PK. Younger age was found to be a strong factor associated with graft rejection. Gender matching might not be compulsory for repeat PK.

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Section: Discussionsupporting

confidence: 92%

Impact of gender mismatch on corneal graft rejection and rejection-related graft failure in repeat penetrating keratoplasty

et al. 2022

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“…For example, transplants done for keratoconus have a greater than 90% chance of the transplanted cornea remaining clear, even decades later, and typically result in excellent visual acuity (20/20) after the healing period. 2 Transplants done urgently for uncontrolled corneal infection or perforation following severe eye injury or for corneal scarring due to inflammatory diseases, such as Stevens-Johnson syndrome, have a poor prognosis for long-term corneal clarity and vision. Rejection of a corneal graft can occur, although this risk is reduced by use of topical steroids and varies from less than 1% to up to 30% based on indication and type of corneal transplant performed.…”

mentioning

confidence: 99%

Update on Corneal Transplant in 2021

Colby

2021

JAMA

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The cornea, the clear anterior-most structure of the eye, is a frequently transplanted tissue, with approximately 48 000 corneal transplants done in the US each year. 1 Approximately 500 μm in thickness in its healthy state, the cornea is composed of 5 layers (Figure , A). From anterior to posterior, these layers include the corneal epithelium and its basement membrane (Bowman layer); the middle layer, or corneal stroma; and the posterior layer of the cornea, the corneal endothelium, with its basement membrane (Descemet membrane). Each layer has a specific function. Common corneal diseases that require transplantation include Fuchs dystrophy, a dysfunction of the endothelium that is the single most common cause for corneal transplant, and keratoconus, a problem with the shape of the cornea that affects the anterior layers of the cornea. Scarring from infection or trauma can occur in any layer.The success rates of corneal transplant and the visual recovery vary according to the initial indication for surgery, as well as the surgical technique used, but in general are quite good. For example, transplants done for keratoconus have a greater than 90% chance of the transplanted cornea remaining clear, even decades later, and typically result in excellent visual acuity (20/20) after the healing period. 2 Transplants done urgently for uncontrolled corneal infection or perforation following severe eye injury or for corneal scarring due to inflammatory diseases, such as Stevens-Johnson syndrome, have a poor prognosis for long-term corneal clarity and vision. Rejection of a corneal graft can occur, although this risk is reduced by use of topical steroids and varies from less than 1% to up to 30% based on indication and type of corneal transplant performed. 3 Corneal transplants can be repeated if needed.There has been an evolution in the types of corneal transplants performed over the past 20 years. Selective replacement of the diseased corneal layer(s) is now the norm, rather than replacement of the entire thickness of the cornea (ie, penetrating keratoplasty [PK];

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“…The OTAG studies established the following findings: oral antiviral treatment reduced the risk of graft failure in primary PK for herpetic keratitis 59 ; the incidence of endophthalmitis after primary PK was 0.67%, with donor cause of death (infection), high-risk cases, and indication for transplant being major risk factors 60 ; there was no difference in graft survival between PK and EK for iridocorneal endothelial (ICE) syndrome, whereas the graft survival in ICE syndrome was intermediate between that of Fuchs endothelial corneal dystrophy (FECD) and PBK 61 ; and young patients with keratoconus had excellent transplant outcomes compared with adults. 62 By combining registry data with postcodematched socioeconomic indices, the OTAG series also demonstrated that patients classified as socioeconomically hard-pressed had an increased risk of graft failure within 5 years compared with the least deprived patients. 63 This study served as a model for how record linkage can enable a registry to identify socioeconomic disparities in disease outcomes on a national level.…”

Section: United Kingdom Transplant Registrymentioning

confidence: 99%

“…114 2016-2021: Bilateral transplant and graft survival, 115 donor age and endothelial cell density on graft survival, 27 2-and 5-year visual outcomes after transplant, 116 emergent corneal grafting in the UK, 117 graft survival in iridocorneal endothelial syndrome, 61 effects of primary disease and corneal neovascularization on grafts, 118 and keratoplasty for young keratoconus. 62 Differential survival of PK and LK after a failed graft. 93 The registry data were able to link with the validated socioeconomic deprivation index in the UK.…”

Section: Origin and Scopementioning

confidence: 99%

Keratoplasty Registries: Lessons Learned

Chu

Liu

et al. 2022

Cornea

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:Clinical registries have been developed for decades in the field of ophthalmology, and they are especially well-suited to the study of keratoplasty practices. A comprehensive donor/recipient registry system can provide insight into donor, recipient, and surgical factors associated with immediate and long-term outcomes and adverse reactions. Furthermore, linkage with demographic databases can elucidate relationships with social determinants of health and potentially shape public policy. The vast sample size and multicenter nature of registries enable researchers to conduct sophisticated multivariate or multilayered analyses. In this review, we aim to emphasize the importance of registry data for keratoplasty practice and 1) summarize the structure of current keratoplasty registries; 2) examine the features and scientific contributions of the registries from Australia, the United Kingdom, Singapore, the Netherlands, Sweden, Eye Bank Association of America, and European Cornea and Cell Transplant registries; 3) compare registry-based studies with large single-site clinical studies; 4) compare registry-based studies with randomized control studies; and 5) make recommendations for future development of keratoplasty registries. Keratoplasty registries have increased our knowledge of corneal transplant practices and their outcomes. Future keratoplasty registry-based studies may be further strengthened by record linkage, data sharing, and international collaboration.

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Keratoplasty for Keratoconus in Young Patients: Demographics, Clinical Features, and Post-transplant Outcomes

Cited by 9 publications

References 27 publications

Impact of gender mismatch on corneal graft rejection and rejection-related graft failure in repeat penetrating keratoplasty

Impact of gender mismatch on corneal graft rejection and rejection-related graft failure in repeat penetrating keratoplasty

Update on Corneal Transplant in 2021

Keratoplasty Registries: Lessons Learned

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