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Full-thickness corneal grafts prove viable at 20 years or longer after surgery
Grafts for keratoconus proved durable and provided good vision despite wound ectasia.
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Penetrating keratoplasty performed for various indications, especially keratoconus, yielded high graft survival rates and good visual outcomes for 20 years or longer, according to a study.
“Among common indications for penetrating keratoplasty, grafts for keratoconus can have excellent survival and visual outcomes,” Anthony F. Felipe, MD, told colleagues at the Wills Eye Institute Alumni Conference in Philadelphia. “Graft-host ectasia and rejection episodes are problems that we encounter in grafts that have survived for 20 years or more. Despite ectasia, patients can still achieve good vision with properly fitted contact lenses and glasses.”
Penetrating keratoplasty is considered the most successful form of tissue transplantation, according to Dr. Felipe.
“There have been studies on long-term outcomes of PK, but only a few have dealt with corneal transplants that have remained clear for 20 years or more,” he said.
Methods, results
Investigators searched electronic medical records at Wills Eye Institute’s Cornea Service for all patients who had undergone PK at the institution. Patients with paper records were also included.
“We looked for patients with first-time PK grafts that were still clear after 20 years or more and were done at Wills Eye Hospital,” Dr. Felipe said. “We wanted to know their indications, visual outcomes and complications, particularly ectasia.”
The retrospective study included 149 eyes of 109 patients. Average patient age at the time of surgery was 37 years. The top three primary indications were keratoconus, Fuchs’ endothelial dystrophy and herpes simplex virus (HSV) keratitis. Mean follow-up was 27 years.
About 80% of all grafts were 20 to 30 years old, with the oldest being 54 years.
Mean postoperative logMAR visual acuity was 0.29 (Snellen equivalent 20/39). Overall, 75% of eyes had Snellen best corrected visual acuity of 20/20 to 20/40 with rigid gas-permeable contact lenses or glasses.
Of eyes that underwent PK for keratoconus, 81% had a BCVA of 20/40 or better.
Good vision despite ectasia
Data showed that the most common complications were rejection, cataracts, and glaucoma. Graft rejection occurred in 28% of cases.
“Early detection and treatment of complications are critical to graft survival and visual outcome. Many cases of rejection can be treated successfully with topical steroids,” Dr. Felipe said.
The majority of corneal ectasia occurred in grafts for keratoconus. Most cases were mild to moderate, located inferiorly, and involved the wound or graft-host junction. Mean postoperative logMAR visual acuity of the ectatic grafts was 0.24 (Snellen equivalent 20/34) with rigid-gas permeable contact lenses and glasses.
“The results of our study show that among corneal transplants at least 20 years or older, penetrating keratoplasty for keratoconus can survive for an extended period of time,” Dr. Felipe said. “Interestingly, many patients who had PK for HSV keratitis still have clear grafts despite episodes of viral recurrence in most patients.”
Investigators were unable to identify the cause of ectasia in most cases.
“With regards to ectasia, there’s also a question of whether this is true graft ectasia or keratoconus recurrence in the graft,” Dr. Felipe said. “We have to assume that ectasia will be due either to progression of the original disease from the remaining host tissue or biomechanical weakening and thinning of the graft-host junction.” – by Matt Hasson
- Anthony F. Felipe, MD, can be reached at Wills Eye Institute, 840 Walnut St., Suite 920, Philadelphia, PA 19107; 215-928-3180; fax: 215-928-3854; email: aflip613@yahoo.com.
- Disclosure: Dr. Felipe has no relevant financial disclosures.