Comparative Analysis of Clinical Outcome in Penetrating Keratoplasty Using Domestic or Imported Cornea

Dong Hyun Kim; Ja Young Lee; Joo Yeon Oh; Hyuk Jin Choi; Mee Kum Kim; Won Ryang Wee

doi:10.7469/JKOS.2015.56.05.672

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Kim, Lee, Oh, Choi, Kim, and Wee: Comparative Analysis of Clinical Outcome in Penetrating Keratoplasty Using Domestic or Imported Cornea

Original Article

J Korean Ophthalmol Soc 2015;56(5):672-679.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.05.672

Comparative Analysis of Clinical Outcome in Penetrating Keratoplasty Using Domestic or Imported Cornea

Dong Hyun Kim, MD^1,², Ja Young Lee, MD³, Joo Yeon Oh, MD, PhD^1,², Hyuk Jin Choi, MD, PhD^1,², Mee Kum Kim, MD, PhD^1,², Won Ryang Wee, MD, PhD^1,²

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea

³Department of Ophthalmology, Soonchunhyang University Gumi Hospital, Soonchunhyang University College of Medicine, Gumi, Korea

￭ Address reprint requests to Mee Kum Kim, MD, PhD Department of Ophthalmology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2665, Fax: 82-2-741-3187 E-mail: kmk9@snu.ac.kr

Received 25 July 201420 October 2014 Accepted 20 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Conclusions:

Our study results suggest that clinical outcomes of the penetrating keratoplasty using imported corneas are com-parable in efficacy when compared with the clinical outcomes using domestic corneas.

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Keywords: Domestic cornea, Endothelial cell density, Imported cornea, Penetrating keratoplasty, Survival

References

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Figure 1.

Kaplan-Meier survival in penetrating keratoplasty using domestic cornea (black) or imported cornea (gray).

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Figure 2.

Kaplan-Meier survival in penetrating keratoplasty combined with cataract surgery using domestic cornea (black) or imported cornea(gray).

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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.

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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.

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Supplementary Figure 1.

Annual report of the keratoplasty in Department of Ophthalmology in Seoul National University Hospital from 1981 to 2011.

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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.

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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.

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Table 1.

Demographics of the patients of penetrating keratoplasty using domestic or imported cornea

	Domestic cornea	Imported cornea
No. of eyes (patients)	108 (104)	128 (122)
Mean age (years, range)	55.7 (17-87)	53.4 (11-84)
Sex (M:F)	55:53	78:50
Laterality (R:L)	57:51	58:70
Prior glaucoma surgery (no. of eyes, %)	15 (13.9)	15 (11.7)
Preoperative lens status (no. of eyes, %)
Phakic	56 (51.8)	82 (64.1)
Pseudophakic	38 (35.2)	36 (28.1)
Aphakic	14 (13.0)	10 (7.8)
Postoperative lens status (no. of eyes, %)
Phakic	29 (26.9)	34 (26.6)
Pseudophakic	66 (61.1)	81 (63.3)
Aphakic	13 (12.0)	13 (10.1)

No statistical significance at all variables.

R = right eye; L = left eye.

Table 2.

Preoperative diagnosis in the patients of penetrating keratoplasty using domestic or imported cornea

Preoperative diagnosis	Domestic cornea (no. of eyes, %)	Imported cornea (no. of eyes, %)
Regrafts	29 (26.9)	26 (20.3)
Corneal opacity/scar	25 (23.1)	35 (27.3)
Pseudophakic bullous keratopathy	23 (21.3)	25 (19.5)
Keratoconus	7 (6.5)	7 (5.5)
Herpes simplex keratitis	6 (5.6)	17 (13.3)
Others	18 (16.7)	18 (14.1)
Total	108	128

No statistical significance at all items.

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)

Values are presented as mean ± SD unless otherwise indicated.

^* p < 0.05 by independent t-test.

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

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; F/U = follow-up.

^* p < 0.05 by independent t-test.

Table 5.

The percentages of combined cataract surgery in penetrating keratoplasty using domestic or imported cornea

Surgeries	Domestic cornea (no. of eyes, %)	Imported cornea (no. of eyes, %)
PKP without combined cataract surgery	71 (65.7)	67 (52.4)
PKP with combined cataract surgery	27 (25)	47 (36.7)
PKP with stepwise cataract surgery	10 (9.3)	14 (10.9)
Total	108	128

No statistical differences between the groups by chi-square test.

PKP = penetrating keratoplasty.

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