Evolution of Corneal Graft Survival Over a 30-Year Period and Comparison of Surgical Techniques: A Cohort Study
| Autor: | Delphine Binda, Elisabeth Monnet, Anne-Sophie Gauthier, Maxime Desmarets, Romain Montard, Maher Saleh, Anne-Sophie Mariet, Mélanie Bidaut-Garnier, Bernard Delbosc, Charlène Ratajczak, Aurélien Prongué |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Graft Rejection Male medicine.medical_specialty Keratoconus Time Factors Corneal graft Visual Acuity Corneal Diseases Cohort Studies Corneal Transplantation 03 medical and health sciences 0302 clinical medicine Risk Factors Medicine Humans Prospective Studies Survival rate Aged business.industry Hazard ratio Graft Survival Surgical procedures Middle Aged medicine.disease Surgery Ophthalmology Treatment Outcome Cohort 030221 ophthalmology & optometry Bullous keratopathy Female France business 030217 neurology & neurosurgery Cohort study Follow-Up Studies |
| Zdroj: | American journal of ophthalmology. 163 |
| ISSN: | 1879-1891 |
| Popis: | Purpose To compare graft survival between 3 10-year periods and according to surgical techniques performed in the last years. Design Cohort study. Methods setting: Regional center (Besancon University Hospital, France). patients: All 1132 patients operated on between 1983 and 2014. Graft and patient baseline characteristics, risk factors for failure, surgical procedures, and postoperative corneal status were collected. main outcome measures: Five-year survival rate in the whole cohort; 1-year and 3-year survival rates, respectively, among 88 patients with endothelial dystrophy (ED) or postoperative bullous keratopathy (PBK) operated on using endothelial lamellar keratoplasty (ELK) or penetrating keratoplasty (PK), and among 56 patients with keratoconus operated on using anterior lamellar keratoplasty (ALK) or PK. Results Between the 1983–1993 and the 2004–2014 periods, overall 5-year graft survival rate increased from 61.4% to 76.5% ( P = .0004). The main prognostic factors were preoperative diagnosis, graft endothelial density, and postoperative lens status. After adjusting for these factors, difference in survival rates was no longer significant (hazard ratio 0.90 for the second and 1.17 for the third period, compared to the first, P = .4191). Only 1 graft failure, after PK, occurred among the 56 patients with keratoconus. Among the 88 patients with ED or PBK, the 1-year graft survival was higher with PK (90.6%) than with ELK (60.8%) ( P = .0025) but no significance remained after adjustment (hazard ratio 3.22, P = .1304). Conclusions Despite numerous changes in graft procedures and surgical techniques, no noticeable improvement in graft survival was found during the last 30 years while taking into account other prognostic factors. |
| Databáze: | OpenAIRE |
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