Abstract

DO.08.01

Long-term prognosis in penetrating keratoplasty for keratoconus

Böhringer D., Poxleitner K., Birnbaum F., Maier P., Sundmacher R., Reinhard T.
Universitäts-Augenklinik Freiburg

Objective: Five year graft survival in penetrating keratoplasty for keratoconus is excellent. Nevertheless, clinical observation points to a limitation of graft survival of around 20 years. Graft failure is either due to loss of transparency or to progression of a recurrent keratoconus. No reliable, long term data on graft prognosis is available yet. We thus tried to systematically follow a cohort that underwent penetrating keratoplasty between 1976 and 1984 at the University Eye Hospital Freiburg, Germany.
Methods: A total of 113 keratoplasties for keratoconus were identified from surgery protocolls from the years 1976 to 1984. Mean patient age was 35 (18-57) years. Surgery was performed using double running cross-stitch sutures and 7.7 mm trephination in almost all cases. No long term organ culture was performed. The fate of the graft was investigated by means of a questionnaire, patients' medial records from outpatient care or other eye hospitals and historic waiting lists from the cornea bank).
Results: A total of 83 patients were lost to follow-up either from death or due to missing address data. Only in 30 patients the state of the graft was recoverable. These patients were followed for a mean of 20±6 (SD) years. Nineteen cases experienced graft failure after a median time interval of 23 years (Kaplan Meier estimation). Eleven grafts remained clear, but are only currently examined for topography and visual acuity.
Conclusions: Despite the inevitable limitations of our investigation, the observed life span of a corneal graft is in concordance to the clinical feeling of about 20 years. Functional impairment form recurrence of keratoconus in the peripheral cornea or the graft is most likely of similar importance. This is beeing currently assessed from clinical examination of the remaining 10 patients with a clear graft.

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