Trends in corneal transplant surgery in Ireland: indications and outcomes of corneal transplant surgery and intraocular lens opacification following Descemet’s stripping automated endothelial keratoplasty

Abstract

To evaluate the indications for corneal transplantation, the procedures carried out, and the postoperative outcomes and to compare these with previous Irish corneal transplant studies. A retrospective review of the case notes of all patients who underwent corneal transplantation under the care of a single surgeon, from 2008 to 2015, was performed. The risk factors for postoperative complications including transplant failure were examined. During the period studied, 42 corneal transplant surgeries were carried out on 40 eyes of 38 patients, 24 of whom were male (63%), median age at surgery was 62years (range 23-96years). The most common indication for transplantation was pseudophakic corneal decompensation associated with Fuch's endothelial dystrophy (FED) (n=13). Seventeen penetrating keratoplasties, 23 lamellar keratoplasties, and two amniotic membrane transplant procedures were carried out. Transplant failure resulting in corneal oedema or repeat corneal transplant surgery (n=4, 10%), was associated with previous transplant failure in the eye; odds ratio (OR)=1.58 (p=0.05), and with comorbid FED, OR=1.50 (p=0.02). Intraocular lens opacification occurred in one lens following DSAEK, giving an incidence rate of 7%. Pseudophakic corneal decompensation is the commonest indication for corneal transplant surgery, with lamellar keratoplasty the most frequent approach in our cohort, reflecting developments observed in corneal transplant surgery elsewhere. Prior corneal transplant failure and Fuch's dystrophy remain important risk factors for failure. The risk of intraocular lens opacification and its potential effects on vision should be elaborated prior to endothelial keratoplasty.