Abstract
Abstract Purpose To analyze graft survival and the outcome of the corneal endothelium after corneal transplantation in a single model to predict the long‐term prognosis of these grafts. Methods Cohort study. Data were prospectively recorded and then analyzed retrospectively. Participants: One thousand one hundred and forty‐four consecutive eyes of 1,144 patients who underwent corneal transplantation between 1992 and 2006. Interventions: Penetrating keratoplasties and deep anterior lamellar keratoplasties. Main Outcome Measures: Slit lamp examination and wide‐field specular microscopy. A joint analysis of endothelial cell loss and time to graft failure was undertaken. From mid‐term simultaneous analysis of graft survival and endothelial cell loss, long‐term graft survival was predicted. Results The observed 5‐ and 10‐year graft survival estimates were, respectively, 74% and 64%. The average endothelial cell density (cell loss) was 2,270 cells/mm2 preoperatively, 1,058 cells/mm2 (‐53%) during the 6th post‐operative year, and 865 (‐61%) cells/mm2 during the 10th post‐operative year. Overall, the predicted graft survival estimate was 27% at 20 years and 2% at 30 years. Both observed and predicted graft survival were higher in patients with lamellar keratoplasty than in patients with penetrating keratoplasty and normal recipient endothelium and higher in patients with penetrating keratoplasty and normal recipient endothelium than in patients with penetrating keratoplasty and impaired recipient endothelium. Conclusion For corneal diseases involving the endothelium, penetrating keratoplasty appears to be a good therapeutic approach in elderly patients as the graft lifespan may be similar to the patient life expectancy. Conversely, for younger patients, penetrating keratoplasty is only a mid‐term therapeutic approach. For corneal diseases not involving the endothelium, deep anterior lamellar keratoplasty appears to be a promising therapeutic approach with higher long‐term expected survival.
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