Corneal Graft Success Over 30 Years: Comparing Surgical Techniques in a Specific French Region

Christopher J. Rapuano, MD


April 05, 2016

Evolution of Corneal Graft Survival Over a 30-Year Period and Comparison of Surgical Techniques: A Cohort Study

Bidaut-Garnier M, Monnet E, Prongué A, et al
Am J Ophthalmol. 2016;163:59-69

Study Summary

The ophthalmology department of Besançon University Hospital provides keratoplasty for any patient living in that region of France, which comprises about 2% of the French population. The authors retrospectively reviewed corneal graft survival for three 10-year periods between 1983 and 2014. They looked at graft and patient baseline characteristics, risks for graft failure, types of surgical procedures, and postoperative corneal status. Of note, all of the data were prospectively collected on a standardized form by a single specialized orthoptist who worked in the department for the entire study period. Outcome measures were the 5-year survival rates for the whole cohort, and 1- and 3-year survival rates for smaller subsets.

Between 1983 and 2014, 1132 first keratoplasties were performed at the authors' center. For the first two study decades, almost all the grafts were penetrating keratoplasties (PKs). From 2004 to 2014, 74% were PKs, 6% were anterior lamellar grafts, and 20% were endothelial keratoplasties (EKs).

The percentage of all grafts performed for keratoconus went from 21% in the first decade to 34% in the second decade, and then down to 26% in the third decade. Grafts for pseudophakic bullous keratopathy (PBK) decreased from 40% in the first decade to 31% in the third decade, whereas grafts for Fuchs dystrophy increased from 1% to 16% from the first to third decades.

The 5-year overall graft survival rate reported a statistically significant increase from 61% to 77% from the first to third decade, but after adjustment for prognostic factors, such as preoperative diagnosis, the graft survival rates were no longer significantly different. Similarly, the 1-year survival rate for PKs for PBK and Fuchs dystrophy was 91% compared with 61% for EK for the same diagnoses, but this difference was not statistically significant after adjustment for prognostic factors, including the EK learning curve. The graft survival in keratoconus was excellent, with only 1 graft failure (a PK) in the study.


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