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PK outcomes best in eyes with keratoconus, stromal dystrophy in Saudi Arabian population
Cornea. 2009;28(8):882-890.
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Primary adult penetrating keratoplasty outcomes varied according to surgical indication in a Saudi Arabian population, a study showed.
"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 cornea edema," the study authors said.
The retrospective review included the medical records of every Saudi Arabian patient age 12 years or older who underwent PK for keratoconus, corneal edema, stromal scarring or stromal dystrophy at one center between 1997 and 2001.
Of 910 eyes included in the study, 464 eyes had keratoconus, 188 eyes had corneal edema, 175 eyes had stromal scarring and 83 eyes had stromal dystrophy.
The 5-year graft survival probability was 96.1% for keratoconus, 71.1% for stromal scarring, 85.9% for stromal dystrophy and 40.3% for corneal edema. Surgical indication was the most significant risk factor affecting graft survival (P < .001), the authors said.
Increasing donor age (P = .004) and number of complications (P < .001) were associated with an elevated risk of graft failure among eyes with corneal edema.
Overall vision improved in 750 eyes (82.4%), was unchanged in 97 eyes (10.7%) and decreased in 63 eyes (6.9%), the authors said.
In this study by Wagoner et al, the results are excellent after penetrating keratoplasty for a population of Saudi Arabian patients. Even though vernal keratoconjunctivitis had a much higher rate of occurrence in their patients than in patients from the U.S., the results are still excellent. Their results, though, for patients with corneal edema as the etiology for their vision loss due to corneal disease were relatively poor in comparison with prior results published from U.S. populations. They attribute these poorer results to the high incidence of ocular surface disease in their patients. In older patients undergoing keratoplasty (or now endothelial transplantation), I routinely use cyclosporine 0.05%, frequent lubrication and aggressive indications for punctal occlusion. These were not routinely performed in the patients in this study, and the aggressive use of these modalities, temporary tarsorrhaphy and the increased use of endothelial transplantation likely would result in improved longevity of transplants in this population.
– David R. Hardten, MD
OSN
Cornea/External Disease Section Editor