Long-term outcomes of endothelial keratoplasty in Chinese eyes at a University Hospital

Abstract

BackgroundEndothelial keratoplasty (EK) is used increasingly for the management of cases with endothelial dysfunction. Long-term outcomes of the surgery are not widely reported in the literature. We report our experience of EK in Chinese eyes at a University teaching hospital.MethodsRetrospective analysis was performed for all cases of EK performed between 2005 and 2009. Data analyzed included indication for surgery, associated surgical procedures, complications, best-corrected visual acuity (BCVA) and overall graft survival.ResultsOverall, 22 eyes of 21 patients underwent EK (13 males, 8 females, mean age 71.8 ± 11.3 years). Pseudophakic bullous keratopathy was the leading indication for surgery (n = 12) followed by Fuchs’ endothelial dystrophy (n = 4), or both (n = 3). Other indications for surgery included failed penetrating keratoplasty (n = 2) and endothelial decompensation due to multiple surgeries (n = 1). Triple procedure was performed in 5 (22.7%) cases. Complications were noted in the form of postoperative interface hemorrhage (n = 2, 9%) and graft dislocation (n = 1, 4.5%). The mean postoperative endothelial cell density was 1069 ± 585.8 cells/mm2. The mean postoperative pachymetry was 675.8 ± 108.5 μm. The mean preoperative and postoperative intraocular pressure was 11.3 ± 3.2 and 13.9 ± 4.5 mmHg respectively. At the last follow-up (mean, 47.4 ± 13.7 months), BCVA was ≥20/70 in 9 (40.9%) cases. Causes of poor BCVA included primary graft failure (n = 4), graft decompensation (n = 4), advanced glaucoma (n = 2) and irreversible graft rejection (n = 2). Graft remained clear in 12 (54.5%) cases at the last follow-up. Average graft survival was 19.7 ± 17.7 months (median 17.5 months).ConclusionsNearly half of the EK grafts in our study survived over a period of five years. Graft failure, glaucoma and graft rejection were the main causes of poor graft survival.

Demography, indications and outcome of descemet stripping automated endothelial keratoplasty in Nepal

“…In our study endothelial dysfunction due to BK (50.5%), Fuchs dystrophy (23.6%) and regraft (11.8%) were three major indications (Table 1). Similar pattern was seen in our neighboring countries, China and India (Basak, 2008;Young et al, 2014). But in Thailand, New York and Italy the common indications were Fuchs (38.8 to 61.5%) followed by BK (Wu et al, 2012;Medi et al, 2019;Lekhanont et al 2017).…”

“…Mean age of subjects in our study was 61.0 years, compared to 41.7 years which was the overall average age of patients who had undergone different types of keratoplasty in our institute (Bajracharya et al, 2013). In India, the mean age of patients undergoing EK was 54 to 58 years (Basak, 2008;Mohamed et al, 2014) but in China and New York it was around 72 years (Young et al, 2014;Wu et al, 2012). Older age was obviously because of patients with BK related to cataract surgery and Fuchs dystrophy, which occur in middle-aged groups (Elhalis et al, 2010).…”

“…In China, male and female patients were almost in equal proportion (Young et al 2014). But in India, male patients were 1.5 to 1.58 times more than females (Basak, 2008;Mohamed et al, 2014).…”

A 20-year bibliometric analysis of Fuchs endothelial corneal dystrophy: from 2001 to 2020

“…Although EK is relatively mature in the treatment of FECD, complications such as graft rejection and graft detachment could not be avoided. It was reported that only half of EK grafts survived over a 5-year period [ 36 ]. In addition, the 5-year graft survival rate was only 77.1% after DSEK [ 37 ].…”

Celebrating 60 years of corneal transplant in Hong Kong

“…Chinese eyes are known to be technically challenging; nonetheless, visual outcomes and complication profiles of procedures conducted in Hong Kong patients are comparable to international standards. [7][8][9] As endothelial keratoplasty gained popularity, in 2008, the HKEB also started to pre-cut corneal tissues for surgeons. Having pre-cut tissues significantly reduces the operating time and obviates any risks of cancellation due to inadvertent graft damage during preparation.…”