Long-term results after penetrating keratoplasty for Fuchs' endothelial dystrophy
O. Pineros, E. J. Cohen, C. J. Rapuano and P. R. Laibson
Cornea Service, Wills Eye Hospital, Philadelphia, PA., USA.
OBJECTIVE: To determine the graft survival, visual outcome, complications,
and frequency of subsequent cataract extraction after penetrating
keratoplasty for Fuchs' dystrophy. DESIGN: The medical records of 236
patients with the diagnosis of Fuchs' dystrophy who were examined on the
Cornea Service at Wills Eye Hospital, Philadelphia, Pa, between January 1,
1988, were reviewed retrospectively. SUBJECTS: Penetrating keratoplasties
had been or were subsequently performed on 130 phakic eyes of the 236
patients with Fuchs' dystrophy. Results were analyzed in 126 eyes with at
least 1 year of follow-up. Statistical analysis was done to determine the
risk factors for subsequent cataract surgery in the first eye of patients
who had penetrating keratoplasty as their initial surgical procedure.
RESULTS: Mean +/- SD follow-up after transplantation was 8.4 +/- 4.8 years.
The graft remained clear in 112 eyes (89%). A best corrected acuity of
20/40 or better was achieved in 81 eyes (64%). Graft rejection occurred in
37 eyes (29%). Subsequent cataract surgery was performed in 55 eyes (44%),
and the mean time from transplantation was 3.5 +/- 3.4 years. Advanced age
at the time of transplantation was a significant risk factor for having
cataract extraction (P = .003, Mantel-Haenszel chi 2 test) and a shorter
time to cataract surgery after penetrating keratoplasty (P = .04,
Mantel-Haenszel chi 2 test). Pregraft lens status approached significance
as a risk factor for subsequent cataract surgery (P = .07, Mantel-Haenszel
chi 2 test). CONCLUSIONS: Long-term results are favorable after penetrating
keratoplasty for Fuchs' dystrophy. In older patients with Fuchs' dystrophy
and mild-to-moderate lens changes, combines penetrating keratoplasty,
cataract extraction, and intraocular lens implantation procedure should be
considered.
