Indications for Keratoplasty in King Abdul-Aziz University Hospital: Five Years of Experience
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Abstract
Background: This study aimed to describe the indications and surgical techniques for corneal transplantation performed at a tertiary hospital over the past five years.
Methods: A retrospective cross-sectional chart review was conducted of medical records for keratoplasty cases admitted to the hospital during this period. For each patient, data were collected on demographic characteristics, clinical indications for keratoplasty, associated ocular conditions, the surgical technique used, graft size, postoperative outcomes, suture removal time, and complication rates.
Results: A total of 132 patients (159 keratoplasties) were included. The leading indications for keratoplasty were keratoconus (74/159, 46.5%), corneal decompensation including pseudophakic bullous keratopathy (37/159, 23.3%), and microbial keratitis (10/159, 6.3%). Penetrating keratoplasty (PKP) was the most commonly performed surgical technique (84/159, 53%), followed by Descemet’s stripping automated endothelial keratoplasty (DSAEK, 35/159, 22%). Postoperatively, mean intraocular pressure remained stable (approximately 16–17 mmHg) throughout follow-up visits. By two months, corneal clarity was achieved in nearly 90% of cases, with gradual improvement in visual acuity up to three months.
Conclusions: The findings highlight key indications and evolving surgical techniques in corneal transplantation, underscoring the importance of early diagnosis and adoption of less invasive procedures to improve patient outcomes. These insights support targeted clinical strategies and resource planning to optimise corneal transplant care.
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References
Gain P, Jullienne R, He Z, Aldossary M, Acquart S, Cognasse F, et al. Global survey of corneal transplantation and eye banking. JAMA Ophthalmol. 2016;134(2):167–173. https://doi.org/10.1001/jamaophthalmol.2015.4776
Zirm EK. Eine erfolgreiche totale Keratoplastik (A successful total keratoplasty). 1906. Refract Corneal Surg. 1989;5(4):258–261. https://doi.org/10.3928/1081-597X-19890701-12
Melles GRJ. Posterior lamellar keratoplasty: DLEK to DSEK to DMEK. Cornea. 2006;25(8):879–881. https://doi.org/10.1097/01.ico.0000243962.60392.4f
Singh R, Gupta N, Vanathi M, Tandon R. Corneal transplantation in the modern era. Indian J Med Res. 2019;150(1):7–22. https://doi.org/10.4103/ijmr.IJMR_141_19
Gorovoy MS. Descemet-stripping automated endothelial keratoplasty. Cornea. 2006;25(8):886–889. https://doi.org/10.1097/01.ico.0000214224.90743.01
Price FW, Price MO. Descemet’s stripping with endothelial keratoplasty in 50 eyes: a refractive neutral corneal transplant. J Refract Surg. 2005;21(4):339–345. https://doi.org/10.3928/1081-597X-20050701-07
Guerra FP, Anshu A, Price MO, Giebel AW, Price FW. Descemet’s membrane endothelial keratoplasty: prospective study of 1-year visual outcomes, graft survival, and endothelial cell loss. Ophthalmology. 2011;118(12):2368–2373. https://doi.org/10.1016/j.ophtha.2011.06.002
Melles GRJ, Ong TS, Ververs B, van der Wees J. Descemet membrane endothelial keratoplasty (DMEK). Cornea. 2006;25(8):987–990. https://doi.org/10.1097/01.ico.0000248385.16896.34
Darlington JK, Adrean SD, Schwab IR. Trends of penetrating keratoplasty in the United States from 1980 to 2004. Ophthalmology. 2006;113(12):2171–2175. https://doi.org/10.1016/j.ophtha.2006.06.034
Al-Arfai KM, Yassin SA, Al-Beshri AS, Al-Jindan MY, Al-Tamimi ER. Indications and techniques employed for keratoplasty in the Eastern province of Saudi Arabia: 6 years of experience. Ann Saudi Med. 2015;35(5):387–393. https://doi.org/10.5144/0256-4947.2015.387
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344–349. https://doi.org/10.1016/j.jclinepi.2007.11.008
World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310(20):2191–2194. https://doi.org/10.1001/jama.2013.281053
Lois N, Kowal VO, Cohen EJ, Rapuano CJ, Gault JA, Raber IM, et al. Indications for penetrating keratoplasty and associated procedures, 1989–1995. Cornea. 1997;16(6):623–649. https://doi.org/10.1097/00003226-199711000-00004
Mendes F, Schaumberg DA, Navon S, Steinert R, Sugar J, Holland EJ, et al. Assessment of visual function after corneal transplantation: the quality of life and psychometric assessment after corneal transplantation (Q-PACT) study. Am J Ophthalmol. 2003;135(6):785–793. https://doi.org/10.1016/S0002-9394(02)02278-X
Randleman JB, Song CD, Palay DA. Indications for and outcomes of penetrating keratoplasty performed by resident surgeons. Am J Ophthalmol. 2003;136(1):68–75. https://doi.org/10.1016/S0002-9394(02)02295-X
Liu E, Slomovic AR. Indications for penetrating keratoplasty in Canada, 1986–1995. Cornea. 1997;16(4):414–419. https://doi.org/10.1097/00003226-199707000-00007
Inoue K, Amano S, Oshika T, Sawa M, Tsuru T. A 10-year review of penetrating keratoplasty. Jpn J Ophthalmol. 2000;44(2):139–145. https://doi.org/10.1016/S0021-5155(99)00190-2
Chaidaroon W, Ngamtiphakorn S, Ausayakhun S, Prasitsilp J. Clinical indications for penetrating keratoplasty in Maharaj Nakorn Chiang Mai Hospital, 1996–1999. J Med Assoc Thail. 2003;86(3):206–211.
Al-Towerki AE, Gonnah ES, Al-Rajhi A, Wagoner MD. Changing indications for corneal transplantation at the King Khaled Eye Specialist Hospital (1983–2002). Cornea. 2004;23(6):584–588. https://doi.org/10.1097/01.ico.0000121708.58571.5b
Matthaei M, Sandhaeger H, Hermel M, Adler W, Jun AS, Cursiefen C, et al. Changing indications in penetrating keratoplasty: a systematic review of 34 years of global reporting. Transplantation. 2017;101(6):1387–1399. https://doi.org/10.1097/TP.0000000000001281
Bozkurt TK, Acar B, Kilavuzoglu AE, Akdemir MO, Hamilton DR, Cosar Yurteri CB, et al. An 11-year review of keratoplasty in a tertiary referral center in Turkey: changing surgical techniques for similar indications. Eye Contact Lens. 2017;43(6):364–370. https://doi.org/10.1097/ICL.0000000000000274
Crawford AZ, McKelvie J, Craig JP, McGhee CNJ, Patel DV. Corneal transplantation in Auckland, New Zealand, 1999–2009: indications, patient characteristics, ethnicity, social deprivation, and access to services. Cornea. 2017;36(5):546–552. https://doi.org/10.1097/ICO.0000000000001159
Edwards M, Clover GM, Brookes N, Pendergrast D, Chaulk J, McGhee CNJ. Indications for corneal transplantation in New Zealand: 1991–1999. Cornea. 2002;21(2):152–155. https://doi.org/10.1097/00003226-200203000-00004
Kanavi MR, Javadi MA, Sanagoo M. Indications for penetrating keratoplasty in Iran. Cornea. 2007;26(5):561–563. https://doi.org/10.1097/ICO.0b013e318041f05c
Hashemi H, Khabazkhoob M, Yazdani N, Ostadimoghaddam H, Norouzirad R, Amanzadeh K, et al. The prevalence of keratoconus in a young population in Mashhad, Iran. Ophthalmic Physiol Opt. 2014;34(5):519–527. https://doi.org/10.1111/opo.12147
Assiri AA, Yousuf BI, Quantock AJ, Murphy PJ, Assiri AA. Incidence and severity of keratoconus in Asir province, Saudi Arabia. Br J Ophthalmol. 2005;89(11):1403–1406. https://doi.org/10.1136/bjo.2005.074955
Jonas JB, Nangia V, Matin A, Kulkarni M, Bhojwani K. Prevalence and associations of keratoconus in rural Maharashtra in Central India: the Central India Eye and Medical Study. Am J Ophthalmol. 2009;148(5):760–765. https://doi.org/10.1016/j.ajo.2009.06.024
Waring GO. The 50-year epidemic of pseudophakic corneal edema. Arch Ophthalmol. 1989;107(5):657–659. https://doi.org/10.1001/archopht.1989.01070010675025
Chan SWS, Yucel Y, Gupta N. New trends in corneal transplants at the University of Toronto. Can J Ophthalmol. 2018;53(6):580–587. https://doi.org/10.1016/j.jcjo.2018.02.023
Palma-Carvajal F, Morales P, Salazar-Villegas A, Figueroa-Vercellino JP, Spencer F, Peraza-Nieves J, et al. Trends in corneal transplantation in a single center in Barcelona, Spain: transitioning to DMEK. J Fr Ophtalmol. 2020;43(1):1–6. https://doi.org/10.1016/j.jfo.2019.06.026
Galvis V, Tello A, Laiton AN, Salcedo SLL. Indications and techniques of corneal transplantation in a referral center in Colombia, South America (2012–2016). Int Ophthalmol. 2019;39(8):1723–1733. https://doi.org/10.1007/s10792-018-0994-z