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초록
Purpose:
To compare the survival of corneal grafts and the changes in endothelial cell density in penetrating keratoplasty using domestic or imported corneas.
Methods:
Medical records of 236 eyes of 211 patients who underwent penetrating keratoplasty from November 2004 to August 2011 in Seoul National University Hospital and were followedup at least 1 year were retrospectively reviewed. After excluding the patients who received the combined surgeries with other surgeries except cataract surgery, the eyes were divided into 2 groups depending on the origin of donor tissue resulting in a domestic cornea group (108 eyes) and an imported cornea group (128 eyes). Recipient demographics, preoperative diagnosis, donor age, death-to-preservation time, death-to-operation time and pre-and postoperative visual acuities were compared between the 2 groups. Kaplan-Meier survival and changes in endothelial cell density were analyzed at 3, 6 and 12 months and then every year.
Results:
The most common preoperative diagnoses were regraft and corneal opacity in the domestic and imported cornea groups, respectively, without statistical difference. Death-to-preservation time was 8.9 hours and 8.0 hours in the domestic and imported cornea groups, respectively, without statistical difference. However, death-to-operation time was longer in the imported cornea group (4.98 days) than in the domestic cornea group (2.18 days). There were no differences in pre- and postoperative visual acuities, decrease in annual changes in endothelial densities and survival up to 3 years between the 2 groups. In addition, the survival and decreased annual changes in endothelial densities were not different from each other in penetrating keratoplasty combined with cataract surgery or in penetrating keratoplasty for a corneal edema.
References
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Figure 1.
Kaplan-Meier survival in penetrating keratoplasty using domestic cornea (black) or imported cornea (gray).
Figure 2.
Kaplan-Meier survival in penetrating keratoplasty combined with cataract surgery using domestic cornea (black) or imported cornea(gray).
Figure 3.
Annual changes of endothelial cell density in total cases of penetrating keratoplasty (A) and in penetrating keratoplasty combined with cataract surgery (B) using domestic cornea (black) or imported cornea (gray). There is no statistical difference between those in all periods. ECD =endothelial cell density.
Figure 4.
Kaplan-Meier survival table (A) and annual endothelial cell changes (B) in penetrating keratoplasty for a bullous keratopathy using domestic cornea (black) or imported cornea (gray). There is no statistical difference between those in all periods. ECD =endothelial cell density.
Supplementary Figure 1.
Annual report of the keratoplasty in Department of Ophthalmology in Seoul National University Hospital from 1981 to 2011.
Supplementary Figure 2.
Annual report of the keratoplasty using domestic or imported cornea in department of Ophthalmology in Seoul National University Hospital from 2003 to 2011.
Supplementary Figure 3.
Kaplan-Meier survival table (A) and annual endothelial cell changes (B) in penetrating keratoplasty performed by one experienced surgeon (K.M.K) using domestic cornea (black) or imported cornea (gray). There is no statistical difference between those in all periods. ECD = endothelial cell density.
Table 1.
Demographics of the patients of penetrating keratoplasty using domestic or imported cornea
Table 2.
Preoperative diagnosis in the patients of penetrating keratoplasty using domestic or imported cornea
Table 3.
Characteristics of the donor cornea
| Domestic cornea | Imported cornea | |
|---|---|---|
| Donor age (years, range)* | 46.8 ± 14.9 (13-74) | 55.5 ± 11.1 (12-71) |
| Death to preservation time (hours) | 8.9 ± 7.7 | 8.0 ± 3.9 |
| Death to transplant time (hours)* | 52.3 ± 24.0 (mean 2.18 days) | 119.6 ± 17.6 (mean 4.98 days) |
| Optisol-GS® (no. of eyes, %) | 108 (100) | 128 (100) |
| Moist chamber (no. of eyes, %) | 0 (0) | 0 (0) |
Table 4.
Clinical outcome of penetrating keratoplasty using domestic or imported cornea
| Domestic cornea | Imported cornea | |
|---|---|---|
| Preoperative BCVA (log MAR) | 1.67 ± 0.33 | 1.67 ± 0.38 |
| Postoperative BCVA (log MAR) | 0.70 ± 0.55 | 0.67 ± 0.55 |
| Graft failures (no. of eyes, %) | ||
| Graft rejection | 25 (23.1) | 29 (22.7) |
|
Late endothelial failure |
10 (9.3) |
3 (2.3) |
| F/U periods (months)* | 33.71 ± 18.54 | 42.30 ± 23.83 |
Table 5.
The percentages of combined cataract surgery in penetrating keratoplasty using domestic or imported cornea
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