title: Indications and outcomes of corneal transplantation in geriatric patients.
abstract: OBJECTIVE
  To identify the most common corneal transplant procedures, indications, coexisting ocular diseases, and outcomes in elderly patients, and to compare younger geriatric patients with super-geriatric patients.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Data of all patients 65 years old and older who underwent corneal transplantation at Wills Eye Institute from April 2007 to January 2013, and were followed up for at least 1 year, were collected. Two hundred seventy-one eyes of 253 patients were divided into 2 groups according to the age of the patient.
  
  
  RESULTS
  Group I (65-79 years old) included 181 eyes and Group II (80 years and older) included 90 eyes. The most common indication was Fuchs endothelial dystrophy, with 78 eyes (43%) in Group I and 34 eyes (38%) in Group II. In Group I, 93 Descemet stripping endothelial keratoplasty (DSEK) (51%), 84 penetrating keratoplasty (PK) (46%), and 4 keratoprosthesis procedures(2%) were performed; in Group II, 37 DSEK (41%), 51 PK (57%), and 2 keratoprosthesis procedures (2%) were performed. Graft survival rate at last visit was 90% for Group I and 88% for Group II. Rejection occurred in 18 Group I eyes (10%) and 7 Group II eyes (8%) (P = .562).
  
  
  CONCLUSIONS
  Endothelial abnormalities were more common indications and keratoconus was a less common indication for surgery in the elderly. Fuchs dystrophy was the leading indication for surgery in both super-geriatric and younger geriatric patients. Graft survival rate was slightly higher in the younger geriatric age group but was not statistically significant. In the elderly, there is an increased prevalence of both glaucoma and retinal diseases that can affect the visual outcomes after corneal transplantation.
authors.affiliation: Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: fulyakama@yahoo.com.
authors.forename: Fulya
authors.initials: F
authors.lastname: Duman
authors.affiliation: Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Kosker
authors.affiliation: Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Kunal
authors.initials: K
authors.lastname: Suri
authors.affiliation: Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Jagadesh C
authors.initials: JC
authors.lastname: Reddy
authors.affiliation: Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Jenny F
authors.initials: JF
authors.lastname: Ma
authors.affiliation: Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Hammersmith
authors.affiliation: Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Parveen K
authors.initials: PK
authors.lastname: Nagra
authors.affiliation: Cornea Service, Wills Eye Institute, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Rapuano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003315:Cornea / Q000502:physiology; D003316:Corneal Diseases / Q000175:diagnosis* / Q000601:surgery*; D016039:Corneal Transplantation; D005260:Female; D005500:Follow-Up Studies; D005853:Geriatrics; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology