Predicted long-term outcome of corneal transplantation.
OBJECTIVE
To analyze graft survival and the outcome of the corneal endothelium after corneal transplantation in a single model to predict the long-term prognosis of these grafts.


METHODS
Cohort study. Data were recorded prospectively and then analyzed retrospectively.


METHODS
One thousand one hundred forty-four consecutive eyes of 1144 patients who underwent corneal transplantation between 1992 and 2006.


METHODS
Penetrating keratoplasty and deep anterior lamellar keratoplasty.


METHODS
Slit-lamp examination and wide-field specular microscopy results. A joint analysis of endothelial cell loss and time to graft failure was undertaken. From midterm simultaneous analysis of graft survival and endothelial cell loss, long-term graft survival was predicted.


RESULTS
The observed 5- and 10-year graft survival estimates were, respectively, 74% and 64%. The average endothelial cell density (cell loss) was 2270 cells/mm(2) before surgery, 1058 cells/mm(2) (-53%) during the sixth postoperative year, and 865 cells/mm(2) (-61%) during the 10th postoperative year. Overall, the predicted graft survival estimate was 27% at 20 years and 2% at 30 years. Both observed and predicted graft survival were higher in patients who had undergone lamellar keratoplasty than in patients who had undergone penetrating keratoplasty and had normal recipient endothelium and higher in patients who had undergone penetrating keratoplasty and had normal recipient endothelium than in patients who had undergone penetrating keratoplasty and had impaired recipient endothelium.


CONCLUSIONS
For corneal diseases involving the endothelium, penetrating keratoplasty seems to be a good therapeutic approach in elderly patients because the graft life-span may be similar to the patient life expectancy. Conversely, for younger patients, penetrating keratoplasty is only a midterm therapeutic approach. For corneal diseases not involving the endothelium, deep anterior lamellar keratoplasty seems to be a promising therapeutic approach with higher long-term expected survival.
Borderie
Vincent M
VM
Department of Ophthalmology, Centre Hospitalier National d'Ophtalmologie des XV-XX, UPMC University of Paris, Paris, France. vincent.borderie@upmc.fr
Boëlle
Pierre-Yves
PY
Touzeau
Olivier
O
Allouch
Cécile
C
Boutboul
Sandrine
S
Laroche
Laurent
L
D000368:Aged; D002452:Cell Count; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation; D004728:Endothelium, Corneal / Q000473:pathology / Q000502:physiology; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D014019:Tissue Donors; D016896:Treatment Outcome