Despite decrease in use, PK still effective in select patients
Despite its decreased use compared with endothelial keratoplasty, the role of penetrating keratoplasty remains an important one for surgeons and offers positive outcomes for appropriate patients, according to a speaker.
“The survival rate at 10 years remains high, and we know the age of the donor does not significantly influence this rate of survival except in the extremes of age groups. The level of vision, although variable and dependent on a number of other factors, can help patients regain the ability to be productive members of society and satisfy their visual needs,” Saba Al-Hashimi, MD, said at Cornea Subspecialty Day at the virtual American Academy of Ophthalmology annual meeting.
According to data from the 2019 Eye Banking Statistical Report from the Eye Bank Association of America, the number of PK grafts performed from 2005 to 2018 steadily declined in the U.S. Although endothelial keratoplasty procedures have largely replaced the need for PK in a corneal edema setting, there are still unique circumstances in which PK is indicated, such as when urgent retinal pathology is evident, he said.
However, the number of PK grafts performed in 2019 increased 0.4% from 2018, with 17,409 completed, suggesting a new steady state of cases performed in the U.S. Of the cases performed in 2019, the most common primary indication for PK was repeat corneal transplantation, Al-Hashimi said.
At 10 years, the Cornea Donor Study showed similar rates of success and graft survival for donors younger than 66 years of age vs. donors 66 years and older, 71% vs. 77%, respectively. Donors age 12 to 33 years had a higher success rate of 96%, while donors older than 71 years had a lower success rate at 10 years of 62%.
Visual outcomes after PK are typically inferior to endothelial keratoplasty but similar to or better than deep anterior lamellar keratoplasty, he said.
“For the foreseeable future, there will still be cases when penetrating keratoplasty is the choice,” Al-Hashimi said.
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Al-Hashimi S. When penetrating keratoplasty is the choice. Presented at: American Academy of Ophthalmology annual meeting; Nov. 13-15, 2020 (virtual meeting).
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