Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure
Importance In New Zealand, repeat keratoplasty has become the second leading indication for corneal transplantation. Background To report the indications, outcomes and survival of repeat keratoplasty and evaluate the risk factors for graft failure. Design Retrospective study in a public corneal serv...
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| Veröffentlicht in: | Clinical & experimental ophthalmology 2019-11, Vol.47 (8), p.987-994 |
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| creator | Lu, Lucy M. Boyle, Alexander B. Niederer, Rachael L. Brookes, Nigel H. McGhee, Charles N. J. Patel, Dipika V. |
| description | Importance
In New Zealand, repeat keratoplasty has become the second leading indication for corneal transplantation.
Background
To report the indications, outcomes and survival of repeat keratoplasty and evaluate the risk factors for graft failure.
Design
Retrospective study in a public corneal service.
Participants
Two hundred nineteen patients undergoing 279 repeat keratoplasty procedures during 1991‐2017.
Methods
The New Zealand National Eye Bank prospectively collects data on all corneal transplants. This was utilized to identify patients undergoing repeat keratoplasty in Auckland. Clinical records were retrospectively reviewed.
Main Outcome Measures
Graft survival and visual outcome.
Results
The repeat keratoplasty technique was penetrating keratoplasty (PK) in 242 cases (86.7%) and endothelial keratoplasty in 37 (13.3%). The most common primary indication was keratoconus (46.6%). The most common indication for repeat keratoplasty was endothelial decompensation (37.6%). For PK performed as a repeat keratoplasty, the median survival in years was 12.0 for first, 3.5 for second and 2.3 for third repeat keratoplasty. Keratoconus had the longest graft survival (median 13.0 years). In surviving grafts, median visual acuity was 6/15 at 1 year and 6/12 at 2 years. On multivariate analysis, regraft number (P = .022), non‐European ethnicity (P = .007), concurrent surgical procedure (P |
| doi_str_mv | 10.1111/ceo.13581 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2251696324</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2333932233</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3531-4314c46b3f628f30a6f7e63da09fcfd07d6a21ab6f29b494b7ca80d593c6de8e3</originalsourceid><addsrcrecordid>eNp1kU1PGzEQhq0KRELaQ_9AZYlLkQj4a51dbijiS0IgVXDpxfJ6x5KTzTq1vUX5A_xuTDZwQGIuM_Y8fsejF6GflJzSHGcG_CnlRUm_oTEVgk0rMqN7u1oKIkboMMYFIaRgXB6gEadMlkyQMXr5A2vQCRsfOtAtTkF3cd3qLunkfIddhy96s8wXzQm-h2f8N1P5cI5vu8aZLRRP8H8X-_za98n4FUScCRxcXGKrTfIhYusDDsOoJQSdfJ4R0yb3XdsH-I72rW4j_NjlCXq6unyc30zvHq5v5xd3U8MLTqeCU2GErLmVrLScaGlnIHmjSWWNbciskZpRXUvLqlpUop4ZXZKmqLiRDZTAJ-j3oLsO_l8PMamViwbavBL4PirGCioryZnI6NEndOH70OXfKcY5rzh7SxN0PFAm-BgDWLUObqXDRlGi3sxR2Ry1NSezv3aKfb2C5oN8dyMDZwPw7FrYfK2k5pcPg-Qr2r6aVg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2333932233</pqid></control><display><type>article</type><title>Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure</title><source>Access via Wiley Online Library</source><creator>Lu, Lucy M. ; Boyle, Alexander B. ; Niederer, Rachael L. ; Brookes, Nigel H. ; McGhee, Charles N. J. ; Patel, Dipika V.</creator><creatorcontrib>Lu, Lucy M. ; Boyle, Alexander B. ; Niederer, Rachael L. ; Brookes, Nigel H. ; McGhee, Charles N. J. ; Patel, Dipika V.</creatorcontrib><description>Importance
In New Zealand, repeat keratoplasty has become the second leading indication for corneal transplantation.
Background
To report the indications, outcomes and survival of repeat keratoplasty and evaluate the risk factors for graft failure.
Design
Retrospective study in a public corneal service.
Participants
Two hundred nineteen patients undergoing 279 repeat keratoplasty procedures during 1991‐2017.
Methods
The New Zealand National Eye Bank prospectively collects data on all corneal transplants. This was utilized to identify patients undergoing repeat keratoplasty in Auckland. Clinical records were retrospectively reviewed.
Main Outcome Measures
Graft survival and visual outcome.
Results
The repeat keratoplasty technique was penetrating keratoplasty (PK) in 242 cases (86.7%) and endothelial keratoplasty in 37 (13.3%). The most common primary indication was keratoconus (46.6%). The most common indication for repeat keratoplasty was endothelial decompensation (37.6%). For PK performed as a repeat keratoplasty, the median survival in years was 12.0 for first, 3.5 for second and 2.3 for third repeat keratoplasty. Keratoconus had the longest graft survival (median 13.0 years). In surviving grafts, median visual acuity was 6/15 at 1 year and 6/12 at 2 years. On multivariate analysis, regraft number (P = .022), non‐European ethnicity (P = .007), concurrent surgical procedure (P < .0005), lower donor endothelial density (P = .028), previous glaucoma surgery (P < .0005), postoperative raised intraocular pressure (P = .001) and graft rejection (P = .032) were associated with keratoplasty failure.
Conclusions and Relevance
Repeat keratoplasty survival is affected by multiple interacting factors and prognosis worsens with each subsequent regraft. These results will help guide clinicians in addressing patients' individual risk factors when embarking on repeat corneal transplant surgery.</description><identifier>ISSN: 1442-6404</identifier><identifier>EISSN: 1442-9071</identifier><identifier>DOI: 10.1111/ceo.13581</identifier><identifier>PMID: 31268240</identifier><language>eng</language><publisher>Melbourne: John Wiley & Sons Australia, Ltd</publisher><subject>Acuity ; Cornea ; Corneal transplantation ; endothelial keratoplasty ; Glaucoma ; Graft rejection ; Grafting ; Grafts ; Indication ; Intraocular pressure ; Keratoconus ; Medical prognosis ; Minority & ethnic groups ; Multivariate analysis ; Patients ; penetrating keratoplasty ; repeat keratoplasty ; Risk factors ; Surgery ; Survival ; Transplantation ; Transplants & implants ; Visual acuity ; Visual aspects</subject><ispartof>Clinical & experimental ophthalmology, 2019-11, Vol.47 (8), p.987-994</ispartof><rights>2019 Royal Australian and New Zealand College of Ophthalmologists</rights><rights>2019 Royal Australian and New Zealand College of Ophthalmologists.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3531-4314c46b3f628f30a6f7e63da09fcfd07d6a21ab6f29b494b7ca80d593c6de8e3</citedby><cites>FETCH-LOGICAL-c3531-4314c46b3f628f30a6f7e63da09fcfd07d6a21ab6f29b494b7ca80d593c6de8e3</cites><orcidid>0000-0001-9994-4631 ; 0000-0001-8800-9947</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fceo.13581$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fceo.13581$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31268240$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lu, Lucy M.</creatorcontrib><creatorcontrib>Boyle, Alexander B.</creatorcontrib><creatorcontrib>Niederer, Rachael L.</creatorcontrib><creatorcontrib>Brookes, Nigel H.</creatorcontrib><creatorcontrib>McGhee, Charles N. J.</creatorcontrib><creatorcontrib>Patel, Dipika V.</creatorcontrib><title>Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure</title><title>Clinical & experimental ophthalmology</title><addtitle>Clin Exp Ophthalmol</addtitle><description>Importance
In New Zealand, repeat keratoplasty has become the second leading indication for corneal transplantation.
Background
To report the indications, outcomes and survival of repeat keratoplasty and evaluate the risk factors for graft failure.
Design
Retrospective study in a public corneal service.
Participants
Two hundred nineteen patients undergoing 279 repeat keratoplasty procedures during 1991‐2017.
Methods
The New Zealand National Eye Bank prospectively collects data on all corneal transplants. This was utilized to identify patients undergoing repeat keratoplasty in Auckland. Clinical records were retrospectively reviewed.
Main Outcome Measures
Graft survival and visual outcome.
Results
The repeat keratoplasty technique was penetrating keratoplasty (PK) in 242 cases (86.7%) and endothelial keratoplasty in 37 (13.3%). The most common primary indication was keratoconus (46.6%). The most common indication for repeat keratoplasty was endothelial decompensation (37.6%). For PK performed as a repeat keratoplasty, the median survival in years was 12.0 for first, 3.5 for second and 2.3 for third repeat keratoplasty. Keratoconus had the longest graft survival (median 13.0 years). In surviving grafts, median visual acuity was 6/15 at 1 year and 6/12 at 2 years. On multivariate analysis, regraft number (P = .022), non‐European ethnicity (P = .007), concurrent surgical procedure (P < .0005), lower donor endothelial density (P = .028), previous glaucoma surgery (P < .0005), postoperative raised intraocular pressure (P = .001) and graft rejection (P = .032) were associated with keratoplasty failure.
Conclusions and Relevance
Repeat keratoplasty survival is affected by multiple interacting factors and prognosis worsens with each subsequent regraft. These results will help guide clinicians in addressing patients' individual risk factors when embarking on repeat corneal transplant surgery.</description><subject>Acuity</subject><subject>Cornea</subject><subject>Corneal transplantation</subject><subject>endothelial keratoplasty</subject><subject>Glaucoma</subject><subject>Graft rejection</subject><subject>Grafting</subject><subject>Grafts</subject><subject>Indication</subject><subject>Intraocular pressure</subject><subject>Keratoconus</subject><subject>Medical prognosis</subject><subject>Minority & ethnic groups</subject><subject>Multivariate analysis</subject><subject>Patients</subject><subject>penetrating keratoplasty</subject><subject>repeat keratoplasty</subject><subject>Risk factors</subject><subject>Surgery</subject><subject>Survival</subject><subject>Transplantation</subject><subject>Transplants & implants</subject><subject>Visual acuity</subject><subject>Visual aspects</subject><issn>1442-6404</issn><issn>1442-9071</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kU1PGzEQhq0KRELaQ_9AZYlLkQj4a51dbijiS0IgVXDpxfJ6x5KTzTq1vUX5A_xuTDZwQGIuM_Y8fsejF6GflJzSHGcG_CnlRUm_oTEVgk0rMqN7u1oKIkboMMYFIaRgXB6gEadMlkyQMXr5A2vQCRsfOtAtTkF3cd3qLunkfIddhy96s8wXzQm-h2f8N1P5cI5vu8aZLRRP8H8X-_za98n4FUScCRxcXGKrTfIhYusDDsOoJQSdfJ4R0yb3XdsH-I72rW4j_NjlCXq6unyc30zvHq5v5xd3U8MLTqeCU2GErLmVrLScaGlnIHmjSWWNbciskZpRXUvLqlpUop4ZXZKmqLiRDZTAJ-j3oLsO_l8PMamViwbavBL4PirGCioryZnI6NEndOH70OXfKcY5rzh7SxN0PFAm-BgDWLUObqXDRlGi3sxR2Ry1NSezv3aKfb2C5oN8dyMDZwPw7FrYfK2k5pcPg-Qr2r6aVg</recordid><startdate>201911</startdate><enddate>201911</enddate><creator>Lu, Lucy M.</creator><creator>Boyle, Alexander B.</creator><creator>Niederer, Rachael L.</creator><creator>Brookes, Nigel H.</creator><creator>McGhee, Charles N. J.</creator><creator>Patel, Dipika V.</creator><general>John Wiley & Sons Australia, Ltd</general><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9994-4631</orcidid><orcidid>https://orcid.org/0000-0001-8800-9947</orcidid></search><sort><creationdate>201911</creationdate><title>Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure</title><author>Lu, Lucy M. ; Boyle, Alexander B. ; Niederer, Rachael L. ; Brookes, Nigel H. ; McGhee, Charles N. J. ; Patel, Dipika V.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3531-4314c46b3f628f30a6f7e63da09fcfd07d6a21ab6f29b494b7ca80d593c6de8e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Acuity</topic><topic>Cornea</topic><topic>Corneal transplantation</topic><topic>endothelial keratoplasty</topic><topic>Glaucoma</topic><topic>Graft rejection</topic><topic>Grafting</topic><topic>Grafts</topic><topic>Indication</topic><topic>Intraocular pressure</topic><topic>Keratoconus</topic><topic>Medical prognosis</topic><topic>Minority & ethnic groups</topic><topic>Multivariate analysis</topic><topic>Patients</topic><topic>penetrating keratoplasty</topic><topic>repeat keratoplasty</topic><topic>Risk factors</topic><topic>Surgery</topic><topic>Survival</topic><topic>Transplantation</topic><topic>Transplants & implants</topic><topic>Visual acuity</topic><topic>Visual aspects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lu, Lucy M.</creatorcontrib><creatorcontrib>Boyle, Alexander B.</creatorcontrib><creatorcontrib>Niederer, Rachael L.</creatorcontrib><creatorcontrib>Brookes, Nigel H.</creatorcontrib><creatorcontrib>McGhee, Charles N. J.</creatorcontrib><creatorcontrib>Patel, Dipika V.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical & experimental ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lu, Lucy M.</au><au>Boyle, Alexander B.</au><au>Niederer, Rachael L.</au><au>Brookes, Nigel H.</au><au>McGhee, Charles N. J.</au><au>Patel, Dipika V.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure</atitle><jtitle>Clinical & experimental ophthalmology</jtitle><addtitle>Clin Exp Ophthalmol</addtitle><date>2019-11</date><risdate>2019</risdate><volume>47</volume><issue>8</issue><spage>987</spage><epage>994</epage><pages>987-994</pages><issn>1442-6404</issn><eissn>1442-9071</eissn><abstract>Importance
In New Zealand, repeat keratoplasty has become the second leading indication for corneal transplantation.
Background
To report the indications, outcomes and survival of repeat keratoplasty and evaluate the risk factors for graft failure.
Design
Retrospective study in a public corneal service.
Participants
Two hundred nineteen patients undergoing 279 repeat keratoplasty procedures during 1991‐2017.
Methods
The New Zealand National Eye Bank prospectively collects data on all corneal transplants. This was utilized to identify patients undergoing repeat keratoplasty in Auckland. Clinical records were retrospectively reviewed.
Main Outcome Measures
Graft survival and visual outcome.
Results
The repeat keratoplasty technique was penetrating keratoplasty (PK) in 242 cases (86.7%) and endothelial keratoplasty in 37 (13.3%). The most common primary indication was keratoconus (46.6%). The most common indication for repeat keratoplasty was endothelial decompensation (37.6%). For PK performed as a repeat keratoplasty, the median survival in years was 12.0 for first, 3.5 for second and 2.3 for third repeat keratoplasty. Keratoconus had the longest graft survival (median 13.0 years). In surviving grafts, median visual acuity was 6/15 at 1 year and 6/12 at 2 years. On multivariate analysis, regraft number (P = .022), non‐European ethnicity (P = .007), concurrent surgical procedure (P < .0005), lower donor endothelial density (P = .028), previous glaucoma surgery (P < .0005), postoperative raised intraocular pressure (P = .001) and graft rejection (P = .032) were associated with keratoplasty failure.
Conclusions and Relevance
Repeat keratoplasty survival is affected by multiple interacting factors and prognosis worsens with each subsequent regraft. These results will help guide clinicians in addressing patients' individual risk factors when embarking on repeat corneal transplant surgery.</abstract><cop>Melbourne</cop><pub>John Wiley & Sons Australia, Ltd</pub><pmid>31268240</pmid><doi>10.1111/ceo.13581</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9994-4631</orcidid><orcidid>https://orcid.org/0000-0001-8800-9947</orcidid></addata></record> |
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| ispartof | Clinical & experimental ophthalmology, 2019-11, Vol.47 (8), p.987-994 |
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| source | Access via Wiley Online Library |
| subjects | Acuity Cornea Corneal transplantation endothelial keratoplasty Glaucoma Graft rejection Grafting Grafts Indication Intraocular pressure Keratoconus Medical prognosis Minority & ethnic groups Multivariate analysis Patients penetrating keratoplasty repeat keratoplasty Risk factors Surgery Survival Transplantation Transplants & implants Visual acuity Visual aspects |
| title | Repeat corneal transplantation in Auckland, New Zealand: Indications, visual outcomes and risk factors for repeat keratoplasty failure |
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