Keratoplasty in tenth decade

Good results can be achieved with corneal grafts in patients in their 90s. Roibeard Ó hÉineacháin reports

Keratoplasty in tenth decade
Roibeard O’hEineachain
Roibeard O’hEineachain
Published: Tuesday, June 1, 2021
Special considerations must be taken into account when performing keratoplasty procedures in very elderly patients, but in the great majority of cases there is good graft survival and good visual outcomes, according to a study presented by Harry Levine at the 25th ESCRS Winter Meeting. “In our experience, corneal transplantation can be considered a safe and successful procedure in improving visual acuity for patients over 90 years of age with the proper preoperative screening. A multi-disciplinary approach involving ophthalmologists, anaesthesiologists and primary care providers is of key importance to achieve good outcomes in this challenging population,” said Levine an MD/MPH candidate at the Miller School of Medicine, University of Miami, Miami, Florida, US. Levine, along with Guillermo Amescua MD, an associate professor of Clinical Ophthalmology and Medical Director of the Ocular Surface Program at the Bascom Palmer Eye Institute, Miami, FL, US, and their colleagues reviewed the charts of 58 eyes of 52 consecutive patients selected from a specimen database from the Florida Lions Eye Bank. All patients were at least 90 years old at the time of surgery, with a mean age of 93.2 years, and all had at least three months of follow-up, he noted. The patients’ indications for surgery were pseudophakic bullous keratopathy in 29%, Fuchs’ endothelial dystrophy in 21%, perforated corneal ulcer in 19%, glaucoma-associated corneal decompensation in 27.6% and band keratopathy in 1.7%. Their ocular comorbidities included glaucoma in 62%, age-related macular degeneration in 24% and prior corneal transplant in 36%. Their systemic comorbidities were hypertension in 81%, hyperlipidaemia in 40.4% and arthritis in 61.5%. The surgeries performed were penetrating keratoplasty (PKP) in 43%, Descemet’s stripping automated endothelial keratoplasty (DSAEK) in 48%, keratoprosthesis in 7% and a patch graft in 1.7%. Concomitant interventions were needed in 60% of cases. All cases were performed under monitored anaesthesia care with peribulbar block and sedation with midazolam and fentanyl or remifentanil. Levine noted that patients’ mean best-corrected visual acuity (BCVA) improved by -0.3 LogMAR (p<0.01) at one postoperative month and by 0.4 LogMAR (p<0.01) at 12 postoperative months. There were no significant differences between the transplant types in terms of their achieved BCVAs. Overall graft survival was 88% at 12 months and 66% at 24 months. Among eyes that underwent PKP, graft survival was 85% at 12 months and 47% at 24 months. Among DSAEKtreated eyes, graft survival was 94% throughout 48 months of follow-up. In the eyes receiving a keratoprosthesis, the implant remained intact throughout 48 months of follow-up. Complications, apart from graft failure or rejection, included intraoperative choroidal haemorrhage in an eye undergoing PKP, pupillary block in a DSAEK-treated eye and retrolenticular membrane in an eye with keratoprosthesis. There were no major complications related to anaesthesia. Harry Levine: h.levine1@med.miami.edu
Latest Articles
ESCRS Today 2025: Happy Anniversaries!

ESCRS celebrates milestones with pioneers in IOLs, LASIK, femtosecond lasers, and corneal transplantation.

Read more...

ESCRS Today 2025: A Congress for Everyone

From YOs to families, the ESCRS Annual Meeting embraces full participation through inclusivity.

Read more...

ESCRS Today 2025: All Eyes on Innovation

Watching out for obstacles and opportunities

Read more...

Beyond the Numbers

Empowering patient participation fosters continuous innovation in cataract surgery.

Read more...

Thinking Beyond the Surgery Room

Practice management workshop focuses on financial operations and AI business applications.

Read more...

Aid Cuts Threaten Global Eye Care Progress

USAID closure leads retreat in development assistance.

Read more...

Supplement: ESCRS Clinical Trends Series: Presbyopia

Read more...

Debate: FS-LASIK or KLEx for Hyperopia?

FS-LASIK has more of a track record, but KLEx offers advantages.

Read more...

Four AI Applications Ready for Practice

Commercial offerings may save time, improve practice and research.

Read more...

Perioperative Medication Regimens for Cataract Surgery

Randomised controlled clinical trial results provide evidence-based guidance.

Read more...