Outcome of corneal transplantation in a private institution in Saudi Arabia

Background The aim of this work was to describe the indications, complications, and outcomes of penetrating keratoplasty (PKP) in Saudi Arabia. Methods In a retrospective, noncomparative interventional case series, the medical records of patients who underwent PKP from January 2000 to December 2008 and had a minimum follow-up of 6 months were reviewed. All corneas were obtained from eye banks in the US. Indications, complications, and outcomes of surgery were recorded. This study was approved by the institutional review board. Results Eighty-five consecutive eyes were included in this study. There were 52 (61.2%) males and 33 (38.8%) females. The median age was 35.0 years (range 3–85 years), and the median follow-up period was 24 months (range 6–108 months). The indications for PKP were keratoconus, bullous keratopathy, corneal scars, corneal dystrophy, and corneal regraft. The overall graft survival time was 88.9 months ± 4.9 months (mean ± standard error of mean, 95% confidence interval [CI] 79.4 months –98.4 months) while the 3-year and 5-year cumulative survival rates were 90.7% and 84.3%, respectively. Surgical indication (P = 0.038), immune rejection (P < 0.001), preoperative corneal vascularization (P = 0.022), and perioperative high intraocular pressure (P = 0.032) were associated significantly with corneal graft failure in univariate analysis. Multivariate analysis reduced these significant associations to rejection (P < 0.001) and vascularization (P = 0.009). Relative risk for failure in rejected cornea was 16.22 (95% CI 4.99–52.69) and in vascularized cornea was 3.89 (95% CI 1.36–11.09). At last visit following PKP, 34 (40%) eyes had best spectacle-corrected visual acuity of 20/40 or better, and 51 (60.0%) eyes had 20/80 or better. Best spectacle-corrected visual acuity was worse than 20/400 in 15 (17.6%) eyes. Conclusion The overall corneal graft survival in a private setting in Saudi Arabia can be excellent. Thorough preoperative evaluation and comprehensive postoperative management are crucial for successful corneal transplantation. A larger multicenter study is recommended to portray the outcome of private corneal transplantation in Saudi Arabia in general.

[1]  B. Seitz,et al.  Changing indications for penetrating keratoplasty in Homburg/Saar from 2001 to 2010—histopathology of 1,200 corneal buttons , 2013, Graefe's Archive for Clinical and Experimental Ophthalmology.

[2]  V. White,et al.  Correlation of clinical and pathologic diagnoses of corneal disease in penetrating keratoplasties in Vancouver: a 10-year review. , 2012, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[3]  D. Ponzin,et al.  Risk Factors for Graft Failure After Penetrating Keratoplasty: 5-Year Follow-Up From the Corneal Transplant Epidemiological Study , 2011, Cornea.

[4]  A. Joussen,et al.  Efficacy of Postoperative Immunosuppression After Keratoplasty in Herpetic Keratitis , 2011, Cornea.

[5]  Sushmita G Shah,et al.  Postoperative risk factors influencing corneal graft survival in the Singapore corneal transplant study. , 2011, American journal of ophthalmology.

[6]  A. Slomovic,et al.  Evolving surgical techniques of and indications for corneal transplantation in Ontario from 2000 to 2009. , 2011, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[7]  E. Szalai,et al.  Corneal transplantation in Hungary (1946–2009) , 2011, Clinical & experimental ophthalmology.

[8]  M. Goldacre,et al.  Trends in corneal graft surgery in the UK , 2010, British Journal of Ophthalmology.

[9]  M. Wagoner,et al.  Outcome of primary adult optical penetrating keratoplasty with imported donor corneas , 2010, International Ophthalmology.

[10]  Amal Bukhari,et al.  Prevalence of Dry Eye in the Normal Population in Jeddah, Saudi Arabia , 2009, Orbit.

[11]  M. Wagoner,et al.  Outcome of Primary Adult Penetrating Keratoplasty in a Saudi Arabian Population , 2009, Cornea.

[12]  M. Zimmerman,et al.  Postoperative Complications After Primary Adult Optical Penetrating Keratoplasty: Prevalence and Impact on Graft Survival , 2009, Cornea.

[13]  Z. Yalniz-Akkaya,et al.  Repeat Penetrating Keratoplasty: Indications and Prognosis, 1995–2005 , 2009, European journal of ophthalmology.

[14]  M. Dana,et al.  Corneal Graft Rejection , 2009, International ophthalmology clinics.

[15]  Y. Chan,et al.  Penetrating keratoplasty in Asian eyes: the Singapore Corneal Transplant Study. , 2008, Ophthalmology.

[16]  T. Fulcher,et al.  Visual outcomes and graft survival following corneal transplants: the need for an Irish National Corneal Transplant Registry , 2008, Irish journal of medical science.

[17]  K. Tabbara.  Pharmacologic strategies in the prevention and treatment of corneal transplant rejection , 2008, International Ophthalmology.

[18]  D. Sellami,et al.  Epidemiology and risk factors for corneal graft rejection. , 2007, Transplantation proceedings.

[19]  M. Zimmerman,et al.  Corneal transplant survival after onset of severe endothelial rejection. , 2007, Ophthalmology.

[20]  M. Wagoner,et al.  Bacterial keratitis after primary pediatric penetrating keratoplasty. , 2007, American journal of ophthalmology.

[21]  M. Zimmerman,et al.  Bacterial keratitis after penetrating keratoplasty: incidence, microbiological profile, graft survival, and visual outcome. , 2007, Ophthalmology.

[22]  N. Sharma,et al.  Infectious keratitis following keratoplasty. , 2007, Survey of ophthalmology.

[23]  D. Larkin,et al.  The first successful full-thickness corneal transplant: a commentary on Eduard Zirm’s landmark paper of 1906 , 2006, British Journal of Ophthalmology.

[24]  M. B. Goren.  The Eye Bank Association of America. , 2006, Comprehensive ophthalmology update.

[25]  D. Ponzin,et al.  The CORTES Study: Corneal Transplant Indications and Graft Survival in an Italian Cohort of Patients , 2006, Cornea.

[26]  H. Al‐Mezaine,et al.  Repeat penetrating keratoplasty: indications, graft survival, and visual outcome , 2006, British Journal of Ophthalmology.

[27]  T. Reinhard,et al.  Current Systemic Immunosuppressive Strategies in Penetrating Keratoplasty , 2006 .

[28]  S Louise Moffatt,et al.  Centennial review of corneal transplantation , 2005, Clinical & experimental ophthalmology.

[29]  R. Tandon,et al.  Indications and outcome of repeat penetrating keratoplasty in India , 2005, BMC ophthalmology.

[30]  K. Tabbara.  Treatment of herpetic keratitis. , 2005, Ophthalmology.

[31]  U. Rehany,et al.  Risk factors for failure of simultaneous penetrating keratoplasty and cataract extraction , 2004, Journal of cataract and refractive surgery.

[32]  M. Wagoner,et al.  Changing Indications for Corneal Transplantation at the King Khaled Eye Specialist Hospital (1983–2002) , 2004, Cornea.

[33]  Robert W. Thompson,et al.  Risk factors for various causes of failure in initial corneal grafts. , 2003, Archives of ophthalmology.

[34]  Robert W. Thompson,et al.  Long-term graft survival after penetrating keratoplasty. , 2003, Ophthalmology.

[35]  A. Dick,et al.  Recent developments in the pharmacological treatment and prevention of corneal graft rejection , 2003, Expert opinion on investigational drugs.

[36]  H. Dua,et al.  Tacrolimus (FK506) in the management of high-risk corneal and limbal grafts. , 2001, Ophthalmology.

[37]  T. Oshika,et al.  Risk factors for corneal graft failure and rejection in penetrating keratoplasty. , 2001, Acta ophthalmologica Scandinavica.

[38]  D. Coster,et al.  The Australian Corneal Graft Registry. 1990 to 1992 report. , 1993, Australian and New Zealand journal of ophthalmology.

[39]  D. Easty,et al.  Effect of mismatches for major histocompatibility complex and minor antigens on corneal graft rejection. , 1991, Investigative ophthalmology & visual science.