Survival Outcome and Prognostic Factors of Corneal Transplantation: A 15-Year Retrospective Cohort Study at King Chulalongkorn Memorial Hospital

Abstract

Purpose

To evaluate long-term survival outcomes and determine the prognostic factors of corneal transplantation performed at a tertiary referral hospital in Thailand.

Design

A 15-year retrospective cohort study.

Materials and Methods

One corneal graft per patient was selected; graft failure was defined as graft opacity due to recurrent disease or endothelial cell dysfunction. Kaplan–Meier survival analysis was performed. Median time to failure was compared using the Log rank test. Prognostic factors were identified using the Cox proportional hazards model.

Results

We enrolled 704 transplanted grafts. Surgical indications were optical (88.5%), therapeutic (10.2%), and tectonic (1.3%). The most common diagnoses were corneal opacity (25.3%), bullous keratopathy (15.8%), and regraft (14.8%). The overall survival rates at 1, 3, 5, and 10 years were 87.5%, 72.0%, 59.2%, and 41.7%, respectively. Univariate analysis identified age, primary diagnosis, graft size, pre-existing glaucoma, prior lens status, prior intraocular surgery, indication for surgery, donor endothelial cell density, and previous graft rejection as prognostic factors for graft failure. Multivariate analysis revealed three prognostic factors: primary diagnosis of perforation/peripheral ulceration/Mooren’s ulcer (hazard ratio [HR]=28.57; 95% confidence interval [CI], 6.32–129.16; P<0.001), active keratitis (HR=24.30; 95% CI, 5.88–100.43; P<0.001), regraft (HR=9.37; 95% CI, 2.27–38.66; P=0.002), and pseudophakic/aphakic bullous keratopathy (HR=7.97; 95% CI, 1.93–32.87; P=0.004); pre-existing glaucoma (HR=1.52; 95% CI, 1.13–2.04; P=0.006); and previous graft rejection (HR=1.95; 95% CI, 1.54–2.48; P<0.001).

Conclusion

Overall corneal graft survival rate was high in the first postoperative year and decreased after that. Primary diagnosis, pre-existing glaucoma, and previous graft rejection negatively influenced graft survival.

Keywords:

• keratoplasty
• Thailand
• survival rate
• risk factor
• prognostic factor

Data Sharing Statement

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval

This study was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University and carried out in accordance with the tenets of the Declaration of Helsinki. Owing to its retrospective design, patient’s written informed consent to study enrollment was waived by the Ethic Committee of the hospital. In addition, all patient data was deidentified.

Acknowledgments

We thank Wasan Panyasang, MSc, the Research Affairs of the Faculty of Medicine, Chulalongkorn University, Bangkok, for biomedical statistical consultation and Thai Red Cross Eye Bank, Thai Red Cross Society, Bangkok, Thailand, for data information.

Disclosure

The abstract was presented orally at the 36th Royal College of Ophthalmologists of Thailand Annual Meeting, November 25, 2015, Khon Kaen, Thailand and presented as a research poster at the 31st Asia-Pacific Academy of Ophthalmology Congress, March 24–27, 2016, Taipei, Taiwan. The authors report no conflicts of interest in this work.