Long-term Outcomes of Repeated Corneal Transplantations: A Prospective Dutch Registry Study

Mor M Dickman; Lindsay S Spekreijse; Suryan L Dunker; Bjorn Winkens; Tos T J M Berendschot; Frank J H M van den Biggelaar; Pieter Jan Kruit; Rudy M M A Nuijts

doi:10.1016/j.ajo.2018.06.018

Long-term Outcomes of Repeated Corneal Transplantations: A Prospective Dutch Registry Study

Mor M Dickman^*, Lindsay S Spekreijse, Suryan L Dunker, Bjorn Winkens, Tos T J M Berendschot, Frank J H M van den Biggelaar, Pieter Jan Kruit, Rudy M M A Nuijts

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

PURPOSE: To compare long-term outcomes of repeated corneal transplantations (CT), based on primary indication (Fuchs endothelial dystrophy, FED vs. pseudophakic bullous keratoplasty, PBK), surgical technique (penetrating keratoplasty, PK vs. endothelial keratoplasty, EK), and indication for repeated grafting.

SETTINGS: Non-randomized treatment comparison with national registry data (Netherlands Organ Transplantation Registry, NOTR).

METHODS: Data on all consecutive repeated CT following primary PK or EK for FED and PBK between 1994 and 2015 was analyzed, with a maximal follow-up of 5 years. Regraft survival was analyzed using Kaplan-Meier survival curves, univariable, and multivariable Cox regression analysis.

SECONDARY OUTCOMES: best corrected visual acuity, spherical equivalent, and refractive astigmatism, were compared using linear mixed model analysis.

RESULTS: A total of 332 repeated CT were analyzed. The number of regrafts increased significantly between 2007 and 2015 (p=0.001). Overall 5-year regraft survival was 60% and was higher for FED vs. PBK (77% vs. 45%, HR=0.40, p<0.001), and re-EK vs. re-PK (81% vs. 55%, HR=0.51, p=0.041). However, multivariable analysis showed no significant difference in survival based on primary indication, surgical technique, and indication for regrafting. Corrected for baseline, secondary outcomes also did not differ between groups.

CONCLUSIONS: We found a significant increase in repeated CT, coinciding with the introduction of EK in the Netherlands. While univariable analysis suggested better overall regraft survival for FED and (re-)EK, multivariable analysis showed no such difference. This may be due to allocation of favorable cases to undergo (re-)EK. Similarly, secondary outcomes were determined by the primary CT technique.

Original language	English
Pages (from-to)	156-165
Number of pages	10
Journal	American Journal of Ophthalmology
Volume	193
Early online date	28 Jun 2018
DOIs	https://doi.org/10.1016/j.ajo.2018.06.018
Publication status	Published - Sept 2018

Keywords

AUTOMATED ENDOTHELIAL KERATOPLASTY
FAILED PENETRATING KERATOPLASTY
GRAFT FAILURE
LEARNING-CURVE
SURVIVAL
RISK
REJECTION
LAMELLAR
TRENDS

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10.1016/j.ajo.2018.06.018

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Cite this

@article{74834815122945bb977996c9492fa24b,

title = "Long-term Outcomes of Repeated Corneal Transplantations: A Prospective Dutch Registry Study",

abstract = "PURPOSE: To compare long-term outcomes of repeated corneal transplantations (CT), based on primary indication (Fuchs endothelial dystrophy, FED vs. pseudophakic bullous keratoplasty, PBK), surgical technique (penetrating keratoplasty, PK vs. endothelial keratoplasty, EK), and indication for repeated grafting.SETTINGS: Non-randomized treatment comparison with national registry data (Netherlands Organ Transplantation Registry, NOTR).METHODS: Data on all consecutive repeated CT following primary PK or EK for FED and PBK between 1994 and 2015 was analyzed, with a maximal follow-up of 5 years. Regraft survival was analyzed using Kaplan-Meier survival curves, univariable, and multivariable Cox regression analysis.SECONDARY OUTCOMES: best corrected visual acuity, spherical equivalent, and refractive astigmatism, were compared using linear mixed model analysis.RESULTS: A total of 332 repeated CT were analyzed. The number of regrafts increased significantly between 2007 and 2015 (p=0.001). Overall 5-year regraft survival was 60% and was higher for FED vs. PBK (77% vs. 45%, HR=0.40, p<0.001), and re-EK vs. re-PK (81% vs. 55%, HR=0.51, p=0.041). However, multivariable analysis showed no significant difference in survival based on primary indication, surgical technique, and indication for regrafting. Corrected for baseline, secondary outcomes also did not differ between groups.CONCLUSIONS: We found a significant increase in repeated CT, coinciding with the introduction of EK in the Netherlands. While univariable analysis suggested better overall regraft survival for FED and (re-)EK, multivariable analysis showed no such difference. This may be due to allocation of favorable cases to undergo (re-)EK. Similarly, secondary outcomes were determined by the primary CT technique.",

keywords = "AUTOMATED ENDOTHELIAL KERATOPLASTY, FAILED PENETRATING KERATOPLASTY, GRAFT FAILURE, LEARNING-CURVE, SURVIVAL, RISK, REJECTION, LAMELLAR, TRENDS",

author = "Dickman, {Mor M} and Spekreijse, {Lindsay S} and Dunker, {Suryan L} and Bjorn Winkens and Berendschot, {Tos T J M} and {van den Biggelaar}, {Frank J H M} and Kruit, {Pieter Jan} and Nuijts, {Rudy M M A}",

note = "Copyright {\textcopyright} 2018. Published by Elsevier Inc.",

year = "2018",

month = sep,

doi = "10.1016/j.ajo.2018.06.018",

language = "English",

volume = "193",

pages = "156--165",

journal = "American Journal of Ophthalmology",

issn = "0002-9394",

publisher = "Elsevier Science",

}

TY - JOUR

T1 - Long-term Outcomes of Repeated Corneal Transplantations

T2 - A Prospective Dutch Registry Study

AU - Dickman, Mor M

AU - Spekreijse, Lindsay S

AU - Dunker, Suryan L

AU - Winkens, Bjorn

AU - Berendschot, Tos T J M

AU - van den Biggelaar, Frank J H M

AU - Kruit, Pieter Jan

AU - Nuijts, Rudy M M A

PY - 2018/9

Y1 - 2018/9

N2 - PURPOSE: To compare long-term outcomes of repeated corneal transplantations (CT), based on primary indication (Fuchs endothelial dystrophy, FED vs. pseudophakic bullous keratoplasty, PBK), surgical technique (penetrating keratoplasty, PK vs. endothelial keratoplasty, EK), and indication for repeated grafting.SETTINGS: Non-randomized treatment comparison with national registry data (Netherlands Organ Transplantation Registry, NOTR).METHODS: Data on all consecutive repeated CT following primary PK or EK for FED and PBK between 1994 and 2015 was analyzed, with a maximal follow-up of 5 years. Regraft survival was analyzed using Kaplan-Meier survival curves, univariable, and multivariable Cox regression analysis.SECONDARY OUTCOMES: best corrected visual acuity, spherical equivalent, and refractive astigmatism, were compared using linear mixed model analysis.RESULTS: A total of 332 repeated CT were analyzed. The number of regrafts increased significantly between 2007 and 2015 (p=0.001). Overall 5-year regraft survival was 60% and was higher for FED vs. PBK (77% vs. 45%, HR=0.40, p<0.001), and re-EK vs. re-PK (81% vs. 55%, HR=0.51, p=0.041). However, multivariable analysis showed no significant difference in survival based on primary indication, surgical technique, and indication for regrafting. Corrected for baseline, secondary outcomes also did not differ between groups.CONCLUSIONS: We found a significant increase in repeated CT, coinciding with the introduction of EK in the Netherlands. While univariable analysis suggested better overall regraft survival for FED and (re-)EK, multivariable analysis showed no such difference. This may be due to allocation of favorable cases to undergo (re-)EK. Similarly, secondary outcomes were determined by the primary CT technique.

AB - PURPOSE: To compare long-term outcomes of repeated corneal transplantations (CT), based on primary indication (Fuchs endothelial dystrophy, FED vs. pseudophakic bullous keratoplasty, PBK), surgical technique (penetrating keratoplasty, PK vs. endothelial keratoplasty, EK), and indication for repeated grafting.SETTINGS: Non-randomized treatment comparison with national registry data (Netherlands Organ Transplantation Registry, NOTR).METHODS: Data on all consecutive repeated CT following primary PK or EK for FED and PBK between 1994 and 2015 was analyzed, with a maximal follow-up of 5 years. Regraft survival was analyzed using Kaplan-Meier survival curves, univariable, and multivariable Cox regression analysis.SECONDARY OUTCOMES: best corrected visual acuity, spherical equivalent, and refractive astigmatism, were compared using linear mixed model analysis.RESULTS: A total of 332 repeated CT were analyzed. The number of regrafts increased significantly between 2007 and 2015 (p=0.001). Overall 5-year regraft survival was 60% and was higher for FED vs. PBK (77% vs. 45%, HR=0.40, p<0.001), and re-EK vs. re-PK (81% vs. 55%, HR=0.51, p=0.041). However, multivariable analysis showed no significant difference in survival based on primary indication, surgical technique, and indication for regrafting. Corrected for baseline, secondary outcomes also did not differ between groups.CONCLUSIONS: We found a significant increase in repeated CT, coinciding with the introduction of EK in the Netherlands. While univariable analysis suggested better overall regraft survival for FED and (re-)EK, multivariable analysis showed no such difference. This may be due to allocation of favorable cases to undergo (re-)EK. Similarly, secondary outcomes were determined by the primary CT technique.

KW - AUTOMATED ENDOTHELIAL KERATOPLASTY

KW - FAILED PENETRATING KERATOPLASTY

KW - GRAFT FAILURE

KW - LEARNING-CURVE

KW - SURVIVAL

KW - RISK

KW - REJECTION

KW - LAMELLAR

KW - TRENDS

U2 - 10.1016/j.ajo.2018.06.018

DO - 10.1016/j.ajo.2018.06.018

M3 - Article

C2 - 29963996

SN - 0002-9394

VL - 193

SP - 156

EP - 165

JO - American Journal of Ophthalmology

JF - American Journal of Ophthalmology

ER -