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Penetrating vs endothelial keratoplasty for the treatment of Fuchs endothelial corneal dystrophy: analysis of the Dutch organ transplantation registry

Poster Details

First Author: M.Dickman THE NETHERLANDS

Co Author(s):    J. Peeters   M. van Dongen   R. Nuijts              

Abstract Details


To compare graft survival, best corrected visual acuity (BCVA) and refractive error following penetrating keratoplasty (PKP) and endothelial keratoplasty (EK) for the treatment of Fuchs Endothelial Corneal Dystrophy (FECD) in the Netherlands.


Observational, multicentre, prospective cohort study (Netherlands National Organ Transplantation Registry, NOTR).


All consecutive patients undergoing primary corneal transplantation for the treatment of FECD in the Netherlands between January 1998 and December 2013 were included in the analysis. Maximum follow-up duration was 5 years (median=39 months). Kaplan Meier functions and Cox regression analysis were used to assess the primary endpoint: graft survival. Secondary endpoints: BCVA and refractive error were compared using independent sample students t-tests.


In total, 3890 transplantations (PKP=1449, EK=2441) were identified. Five-year survival of PKP and EK grafts was comparable (log rank statistic=2.359, p=0.125; HR=1.228, p=0.125), with survival rates of 93,3% and 94,6%, respectively. However, one-year survival following EK was significantly lower (98,8% vs. 95,7%, log rank statistic 24.35, p=<0.001; HR=3.30, p<0.001). One year BCVA was significantly better following EK (0.43±0.35logMAR vs. 0.28±0.27logMAR, p<0.001). Refractive Astigmatism was significantly lower following EK (-3.57±2.16D vs. -1.67±1.19D, p<0.001).


In the Netherlands, long-term graft survival rates following EK and PKP for the treatment of FECD are high and comparable, despite lower short term survival for EK. EK is associated with better postoperative BCVA and less refractive astigmatism. These results confirm the leading role of EK as the preferred transplantation technique for FECD and can be used as a benchmark for future innovative endothelial transplantation techniques.

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