Changing Practice Patterns and Long-term Outcomes of Endothelial Versus Penetrating Keratoplasty: A Prospective Dutch Registry Study - 12/10/16
, Jean Marie P.W.U. Peeters a, Frank J.H.M. van den Biggelaar a, Ton A.W. Ambergen b, Martin C.J.M. van Dongen c, Pieter Jan Kruit d, Rudy M.M.A. Nuijts aAbstract |
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.
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| Supplemental Material available at AJO.com. |
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| Mor M. Dickman and Jean Marie P.W.U. Peeters contributed equally to this work. |
Vol 170
P. 133-142 - octobre 2016 Retour au numéro
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