Outcome of primary adult penetrating keratoplasty in a Saudi Arabian population.
ABSTRACT To evaluate the outcome of primary adult optical penetrating keratoplasty (PKP) in a Saudi Arabian population.
A retrospective review was performed of the medical records of every Saudi Arabian patient 12 years of age or older who underwent PKP for keratoconus, corneal edema, stromal scarring, or stromal dystrophy at King Khaled Eye Specialist Hospital between January 1, 1997, and December 31, 2001, and for whom a minimum of 3 months of follow-up was available.
Of 910 eyes that met the inclusion criteria, there were 464 eyes with keratoconus, 188 eyes with corneal edema, 175 eyes with stromal scarring, and 83 eyes with stromal dystrophy. The 5-year survival probability was 96.1% for keratoconus, 71.1% for stromal scarring, 85.9% for stromal dystrophy, and 40.3% for corneal edema. The most significant risk factor affecting graft survival was surgical indication (P < 0.001). Among eyes with corneal edema, increasing donor age (P = 0.004) and the occurrence of one or more complications (P < 0.001) were significantly associated with an increased risk of graft failure. Overall, improvement in vision occurred in 750 (82.4%) eyes, remained the same in 97 (10.7%) eyes, and worsened in 63 (6.9%) eyes.
In the Saudi Arabian population, the prognosis for graft survival and improved visual acuity is excellent for eyes with keratoconus and stromal dystrophy, good for stromal scarring, and poor for eyes with corneal edema.
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ABSTRACT: The success of penetrating keratoplasty (PKP) after penetrating eye injuries is often worse than in keratoplasty with Fuchs' endothelial dystrophy. However, comparable investigations are rare. Therefore, we have retrospectively analyzed the results and complication rates of PKPs in patients who experienced penetrating eye injuries. Between 1990 and 1997 forty-four patients who received a corneal transplant at Kiel University Eye Hospital after penetrating eye injury (study group S) were analyzed. 29 patients were re-examined (visual acuity testing, slit lamp microscopy, applanation tonometry, stereo testing, corneal TMS topography, keratometry, endothelial microscopy, perimetry, indirect retinoscopy, testing of the retinal visual acuity and probatory contact lens fitting). Postoperative follow-up ranged between 1 and 6 years (median 3 years). The results were compared to a group of corneal grafts performed in patients with Fuchs' endothelial dystrophy (K, n = 18 patients, 25 eyes, median follow-up 2.8 years). 38males and 6 women had had a bilateral visual acuity of 0.8 or better before the accident, except for three cases. At the time of eye injury the patients' age ranged from 4 to 76 years. The eye trauma was caused by splinters of metal (45 %), glass (20 %), wood (16 %) or stone (11 %). In 73 % of the cases the injury was confined to the anterior segment of the eye (S1). The posterior part of the eye was involved in 27 % (S2). BCVA of S before keratoplasty (KP) was 1/15 on average (K 0.2), at least one year after KP 0.25 (K 0.4); post KP S1 was better than S2 (p = 0.0234), and K better than S (p = 0.0009). In group S 29 patients received a graft at random because of a central corneal scar, 14 patients received an HLA-typed graft with 2.3 mismatches on average. 93 % of the grafts (41 patients) were clear at the last examination, 8 patients showed rejection episodes, half of them were reversible. 5 patients received a second graft because of an irreversible rejection or endothelial decompensation. BCVA improved by at least one line in 84 % in S (K 92 %). BCVA was unchanged after KP in 6.8 % (K 8 %). In 9.1 % of S BCVA after KP was worse (K 0 %). 32 out of 44 patients had a BCVA of 0.1 or better after the last check-up, 13 out of 44 patients presented with a BCVA of 0.5 or better (K40 %). 15 out of 29 patients separately tested showed stereopsis compared to 8 preoperatively in S. In 48 % of the patients studied stereovision could not be restored. 82 % of the patients suffered from topographical irregular astigmatism in S, the superficial geometry of recipient's cornea seems relevant for astigmatism of the graft. Frequent postsurgical complications consisted of secondary glaucoma (S 27 %, K 4 %), immunological rejections (S 18 %, K 0 %), and amblyopia (S 14 %, K 0 %). Compared to patients with Fuchs' dystrophy the results of grafting after eye injuries are significantly worse. This relates to BCVA, astigmatism, frequency of secondary glaucoma and graft rejection.Klinische Monatsblätter für Augenheilkunde 09/2004; 221(8):658-73. · 0.70 Impact Factor
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ABSTRACT: Closed-loop anterior chamber intraocular lenses (AC IOLs) are associated with a high incidence of pseudophakic bullous keratopathy (PBK). The prognosis for recovery of vision with penetrating keratoplasty and the exchange of one type of AC IOL for another remains controversial. A total of 40 consecutive patients with closed-loop AC IOLs and varying degrees of PBK underwent penetrating keratoplasty, explanation of the closed-loop AC IOL, and implantation of a flexible tripod AC IOL--all done with a uniform technique. The average follow-up study was 24 months. Average preoperative visual acuity was 20/170 (range, 20/25-hand motions) and average postoperative visual acuity was 20/44 (range, 20/20-no light perception). A total of 23 eyes (57.5%) achieved a visual acuity of 20/40 or better. Eleven eyes (27.5%) had a visual acuity of 20/200 or worse. Persistent cystoid macular edema was the most frequent cause of poor vision postoperatively (4 eyes), followed by age-related macular degeneration (3 eyes) and graft rejection (2 eyes). This is the first series documenting a good visual outcome for at least 2 years after penetrating keratoplasty and exchange of a closed-loop AC IOL for a single type of flexible tripod AC IOL.Ophthalmology 05/1990; 97(4):407-12; discussion 413-4. · 5.56 Impact Factor
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ABSTRACT: The clinical and specular microscopic results of 40 cases (39 patients) of penetrating keratoplasty during which a Kelman-style anterior chamber intraocular lens was implanted were reviewed retrospectively. Thirty-one pseudophakic eyes received an intraocular lens exchange and nine aphakic eyes received a secondary intraocular lens. Postoperative follow-up averaged 24.5 months (range, 3 to 51 months). At 1, 2, and 3 years after keratoplasty, 39.3%, 63.2%, and 63.6% of eyes, respectively, had visual acuities of 20/40 or better. Ninety-five percent of the grafts remained clear. Causes of poor postoperative visual acuity included cystoid macular edema (32.5%), new glaucoma (22.5%), and age-related macular degeneration (10.0%). Other causes were endothelial rejection leading to graft failure, corneal ulceration, and retinal detachment. Corneal endothelial cell loss by specular microscopy was 11.5% at 1 years, 21.3% at 2 years, and 25.0% at 3 years. These results were compared with cell loss associated with iris-sutured posterior chamber lenses in penetrating keratoplasty. Visual outcomes and complication rates were similar between these two methods; however, the endothelial attrition at 1 and 2 years for the sutured posterior chamber lens was greater than that of the Kelman anterior chamber lens.Ophthalmology 07/1991; 98(6):875-80. · 5.56 Impact Factor