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New Options, Better Outcomes for Corneal Surgery

Each year, roughly 33,000 Americans undergo corneal transplant (CT) surgery to replace a diseased or injured cornea, the tough, transparent dome that helps focus light, is replaced. With the aging of the population, the volume of repeated CT surgery is expected to increase worldwide.

To treat corneal transplant, patients may have one or more options, including endothelial keratoplasty (EK), which surgical replaces the inner layer of damaged cornea tissue with healthy donor tissue or penetrating keratoplasty (PK), in which the entire diseased or damaged cornea is removed with a healthy donor cornea. The recovery period after PK is longer than other types of corneal transplants. It may take up to a year for patients to regain complete vision. 

What Does Research Show?

In about 90 percent of cases, patients’ vision improves after cornea transplant (CT) surgery, according to the National Eye Institute. But less than 10 percent of the time, the corneal graft bed can become inflamed, which leads to a greater than 50 percent failure rate. To help improve patient outcomes and to avoid the need for repeated ophthalmologic surgery, a Dutch study in the American Journal of Ophthalmology compared long-term outcomes of repeated corneal transplantations, based on primary indication (Fuchs endothelial dystrophy versus pseudophakic bullous keratoplasty, which can result from cataract surgery) and surgical technique: EK versus PK, with a maximum follow-up of five years. 

 “Endothelial keratoplasty has largely replaced penetrating keratoplasty as the procedure of choice in the primary treatment of corneal endothelial dysfunction,” the authors wrote. “In a recent Dutch registry study, we showed that the advantages of primary EK over PK resulted in a significant increase in the volume of primary EK and a paradigm shift toward earlier surgical intervention.” 

The results were eye opening. “We found a significant increase in repeated CT, coinciding with the introduction of EK in the Netherlands,” the researchers wrote. “While univariable analysis suggested better overall regraft survival for FED and (re-)EK, multivariable analysis showed no such difference. This may be owing to allocation of favorable cases to undergo (re-) EK.” 

What Can Healthcare Providers Do?

Overall, corneal transplants can safely be repeated multiple times as long as there is a reasonable chance of success and the eye and patient can tolerate additional procedures. But this study may be useful when counseling patients about which type of corneal surgery to choose. 

To manage patients who may require repeated corneal or other ophthalmologic surgeries, encourage them to come in for a professional eye exam as often as recommended by their doctor, even if they don’t have symptoms. Emphasize that regular eye exams are the cornerstone of visual health as you age. After corneal surgery, patients may still need eyeglasses or contact lenses to achieve clear vision. After the transplant is fully healed, laser correction may be an option to correct astigmatism, farsightedness or nearsightness. Vision problems can still result from other eye problems too. 

Also, encourage patients to administer eye drops or other medication exactly as prescribed, and to safeguard their sight by eating a healthy diet with lots of fruits and vegetables, avoiding smoking, wearing sunglasses year ‘round and to play it safe by protecting their eyes from injury, such as wearing protective eyewear when doing projects around the house. 

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