Indications and Outcomes of Corneal Transplantation in Geriatric Patients

• Published in: American journal of ophthalmology 2013-09, Vol.156 (3), p.600-607.e2
• Main Authors: Duman, Fulya, Kosker, Mustafa, Suri, Kunal, Reddy, Jagadesh C, Ma, Jenny F, Hammersmith, Kristin M, Nagra, Parveen K, Rapuano, Christopher J
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Comorbidity; Cornea; Cornea - physiology; Corneal Diseases - diagnosis; Corneal Diseases - surgery; Corneal Transplantation; Female; Follow-Up Studies; Geriatrics; Graft Survival - physiology; Humans; Male; Ophthalmology; Population; Retrospective Studies; Surgery; Surgical techniques; Transplants & implants; Treatment Outcome; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2013.04.034

Purpose To identify the most common corneal transplant procedures, indications, coexisting ocular diseases, and outcomes in elderly patients, and to compare younger geriatric patients with super-geriatric patients. Design Retrospective case series. Methods Data of all patients 65 years old and older who underwent corneal transplantation at Wills Eye Institute from April 2007 to January 2013, and were followed up for at least 1 year, were collected. Two hundred seventy-one eyes of 253 patients were divided into 2 groups according to the age of the patient. Results Group I (65-79 years old) included 181 eyes and Group II (80 years and older) included 90 eyes. The most common indication was Fuchs endothelial dystrophy, with 78 eyes (43%) in Group I and 34 eyes (38%) in Group II. In Group I, 93 Descemet stripping endothelial keratoplasty (DSEK) (51%), 84 penetrating keratoplasty (PK) (46%), and 4 keratoprosthesis procedures(2%) were performed; in Group II, 37 DSEK (41%), 51 PK (57%), and 2 keratoprosthesis procedures (2%) were performed. Graft survival rate at last visit was 90% for Group I and 88% for Group II. Rejection occurred in 18 Group I eyes (10%) and 7 Group II eyes (8%) ( P  = .562). Conclusion Endothelial abnormalities were more common indications and keratoconus was a less common indication for surgery in the elderly. Fuchs dystrophy was the leading indication for surgery in both super-geriatric and younger geriatric patients. Graft survival rate was slightly higher in the younger geriatric age group but was not statistically significant. In the elderly, there is an increased prevalence of both glaucoma and retinal diseases that can affect the visual outcomes after corneal transplantation.