Mélanie Bidaut-Garnier1, Elisabeth Monnet2, Aurélien Prongué3, Romain Montard3, Anne-Sophie Gauthier4, Maxime Desmarets5, Anne-Sophie Mariet6, Charlène Ratajczak7, Delphine Binda5, Maher Saleh4, Bernard Delbosc4. 1. 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. 2. 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. 3. Department of Ophthalmology, Regional University Hospital of Besançon, Besançon, France. 4. 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. 5. Clinical Investigation Center - Inserm CIC1431, Regional University Hospital of Besançon, FHU "InCREASe" (INtegrated Center for Research in inflammatory diseASEs), Besançon, France. 6. Department of Biostatistics and Medical Informatics (Service de Biostatistique et d'Informatique Médicale - DIM), Regional University Hospital of Dijon, University of Burgundy, Dijon, France. 7. Department of Ophthalmology, Regional University Hospital of Besançon, Besançon, France; Clinical Research and Innovation Delegation (DRCI), Regional University Hospital of Besançon, Besançon, France.
Abstract
PURPOSE: To compare graft survival between 3 10-year periods and according to surgical techniques performed in the last years. DESIGN: Cohort study. METHODS: setting: Regional center (Besançon University Hospital, France). PATIENTS: 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. MAIN OUTCOME MEASURES: 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.
PURPOSE: To compare graft survival between 3 10-year periods and according to surgical techniques performed in the last years. DESIGN: Cohort study. METHODS: setting: Regional center (Besançon University Hospital, France). PATIENTS: 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. MAIN OUTCOME MEASURES: 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: Rafael Ignacio Barraquer; Luis Pareja-Aricò; Alba Gómez-Benlloch; Ralph Michael Journal: Medicine (Baltimore) Date: 2019-04 Impact factor: 1.817