title: Evolution of Corneal Graft Survival Over a 30-Year Period and Comparison of Surgical Techniques: A Cohort Study.
abstract: OBJECTIVE
  To compare graft survival between 3 10-year periods and according to surgical techniques performed in the last years.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  setting: Regional center (Besançon University Hospital, France).
  
  
  METHODS
  All 1132 patients operated on between 1983 and 2014. Graft and patient baseline characteristics, risk factors for failure, surgical procedures, and postoperative corneal status were collected.
  
  
  METHODS
  Five-year survival rate in the whole cohort; 1-year and 3-year survival rates, respectively, among 88 patients with endothelial dystrophy (ED) or postoperative bullous keratopathy (PBK) operated on using endothelial lamellar keratoplasty (ELK) or penetrating keratoplasty (PK), and among 56 patients with keratoconus operated on using anterior lamellar keratoplasty (ALK) or PK.
  
  
  RESULTS
  Between the 1983-1993 and the 2004-2014 periods, overall 5-year graft survival rate increased from 61.4% to 76.5% (P = .0004). The main prognostic factors were preoperative diagnosis, graft endothelial density, and postoperative lens status. After adjusting for these factors, difference in survival rates was no longer significant (hazard ratio 0.90 for the second and 1.17 for the third period, compared to the first, P = .4191). Only 1 graft failure, after PK, occurred among the 56 patients with keratoconus. Among the 88 patients with ED or PBK, the 1-year graft survival was higher with PK (90.6%) than with ELK (60.8%) (P = .0025) but no significance remained after adjustment (hazard ratio 3.22, P = .1304).
  
  
  CONCLUSIONS
  Despite numerous changes in graft procedures and surgical techniques, no noticeable improvement in graft survival was found during the last 30 years while taking into account other prognostic factors.
authors.affiliation: Department of Ophthalmology, Regional University Hospital of Besançon, Besançon, France; Clinical Investigation Center - Inserm CIC1431, Regional University Hospital of Besançon, FHU "InCREASe" (INtegrated Center for Research in inflammatory diseASEs), Besançon, France. Electronic address: melaniebidaut@me.com.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Bidaut-Garnier
authors.affiliation: Clinical Investigation Center - Inserm CIC1431, Regional University Hospital of Besançon, FHU "InCREASe" (INtegrated Center for Research in inflammatory diseASEs), Besançon, France; EA 4266, "Pathogenic Agents and Inflammation," University of Franche-Comté, Besançon, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Monnet
authors.affiliation: Department of Ophthalmology, Regional University Hospital of Besançon, Besançon, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Prongué
authors.affiliation: Department of Ophthalmology, Regional University Hospital of Besançon, Besançon, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Montard
authors.affiliation: Department of Ophthalmology, Regional University Hospital of Besançon, Besançon, France; UMR 1098, Inserm/French Blood Services (EFS)/Burgundy Franche-Comté/University of Franche-Comté, Besançon, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Gauthier
authors.affiliation: Clinical Investigation Center - Inserm CIC1431, Regional University Hospital of Besançon, FHU "InCREASe" (INtegrated Center for Research in inflammatory diseASEs), Besançon, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Desmarets
authors.affiliation: Department of Biostatistics and Medical Informatics (Service de Biostatistique et d'Informatique Médicale - DIM), Regional University Hospital of Dijon, University of Burgundy, Dijon, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Mariet
authors.affiliation: Department of Ophthalmology, Regional University Hospital of Besançon, Besançon, France; Clinical Research and Innovation Delegation (DRCI), Regional University Hospital of Besançon, Besançon, France.
authors.forename: Charlène
authors.initials: C
authors.lastname: Ratajczak
authors.affiliation: Clinical Investigation Center - Inserm CIC1431, Regional University Hospital of Besançon, FHU "InCREASe" (INtegrated Center for Research in inflammatory diseASEs), Besançon, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Binda
authors.affiliation: Department of Ophthalmology, Regional University Hospital of Besançon, Besançon, France; UMR 1098, Inserm/French Blood Services (EFS)/Burgundy Franche-Comté/University of Franche-Comté, Besançon, France.
authors.forename: Maher
authors.initials: M
authors.lastname: Saleh
authors.affiliation: Department of Ophthalmology, Regional University Hospital of Besançon, Besançon, France; UMR 1098, Inserm/French Blood Services (EFS)/Burgundy Franche-Comté/University of Franche-Comté, Besançon, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Delbosc
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014792:Visual Acuity