Outcome of primary adult optical penetrating keratoplasty in a public health service facility of a developing country

[摘要] Purpose: To evaluate the outcome of primary adult optical penetrating keratoplasty(PKP) at a public health service hospital of a developing country.Patients and Methods: A retrospective review was performed of the medical records ofevery patient 12 years of age or older who underwent PKP for keratoconus, cornealedema, stromal scarring, or stromal dystrophy at King Khaled Eye Specialist Hospital inthe Kingdom of Saudi Arabia between January 1, 1997, and December 31, 2001, and forwhom a minimum of 3 months' follow-up was available.Results: Of 910 eyes that met the inclusion criteria, there were 464 eyes withkeratoconus, 188 eyes with corneal edema, 175 eyes with stromal scarring, and 83 eyeswith stromal dystrophy. For the entire group, the probability of graft survival was 96.7%at 1 year, 86.2% at 3 years, and 80.9% at 5 years. Five-year survival probability was bestwith keratoconus (96.1%), followed by stromal dystrophy (85.9%), stromal scarring(71.1%), and corneal edema (40.3%). The probability of graft survival differedsignificantly among the surgical indications at all postoperative intervals (P<0.001).Factors associated with a significantly increased risk of graft failure on multivariate Coxproportional hazard regression analysis included increasing donor tissue age (P = 0.005)and decreasing recipient graft size (P = 0.02). Final visual acuity of 20/40 or better wasobtained in 409 (44.9%) eyes. Visual acuity of 20/40 or better was obtained in 336(72.4%) eyes with keratoconus and in 53 (63.9%) eyes with stromal dystrophy but inonly 11 (6.3%) eyes with stromal scarring and 9 (4.8%) eyes with corneal edema(P<0.001). Overall, improvement in vision occurred in 750 (82.4%) eyes, remained thesame in 97 (10.7%) eyes, and worsened in 63 (6.9%) eyes.Conclusions: The present study has conclusively demonstrated that primary adultoptical PKP can be performed at a public health facility in the Kingdom of Saudi Arabiawith graft survival and visual results that are comparable to those obtained in welldevelopedWestern facilities. This success is attributed to the presence of a suitableinfrastructure that provides modern eye care facilities, donor tissue, and pharmaceuticalsto patients who have access to preoperative screening and evaluation, surgicalintervention, and postoperative care by well-trained ophthalmologists and ancillarysupport personnel.

[发布机构] Stellenbosch University