Cornea - ARVO

ARVO 2013 Annual Meeting Abstracts by Scientific Section/Group - CorneaProgram Number: 3074 Poster Board Number: D0009Presentation Time: 8:30 AM - 10:15 AMComparison Of Graft Survival Following PenetratingKeratoplasty And Descemet’s Stripping Endothelial KeratoplastyIn Medically And Surgically Treated Glaucoma PatientsGeorge C. Papachristou, David S. Greenfield, Terrence P. O'Brien,Joyce C. Schiffman, Wei Shi, Shawn M. Iverson. Ophthalmology,Bascom Palmer Eye Institute, Palm Beach Gardens, FL.Purpose: To compare corneal graft survival rate after primarypenetrating keratoplasty (PK) and Descemet’s stripping endothelialkeratoplasty (DSEK) in patients with medically and surgically treatedglaucoma.Methods: A retrospective review of patients who underwent primarycorneal transplant surgery (PK or DSEK) at Bascom Palmer EyeInstitute with pre-existing glaucoma from January 1, 2005 toDecember 31, 2010. Inclusion criteria consisted of patients withglaucomatous optic nerve damage and visual field loss, age ≥ 18,corneal decompensation requiring corneal transplant surgery, and ≥6months of follow-up. Only the first eye per patient was selected.Graft failure was defined as >3 months of corneal edema or opacity,resulting in loss of optical clarity correctable only by surgery.Corneal graft survival was calculated using Kaplan-Meier survivalanalysis and risk factors were evaluated using Cox proportionalhazards analysis.Results: A total of 332 corneal transplants (261 PK, 97 DSEK) wereperformed during the study period. Fifty-five eyes (28 PK, 27 DSEK)from 55 patients (mean age 73±13 yrs in PK and 76±10 in the DSEKgroup, p =0.32) met the enrollment criteria and were selected forreview. Glaucoma diagnoses consisted of POAG 28(51%), PXFG12(22%), CACG 7(13%), uveitic glaucoma 4(7%), NTG 2(4%), andothers 2(4%). The 1, 3, and 5-year graft survival rates in the PKgroup (87%, 47%, and 47%) were compared with the DSEK group(57%, 36%, and 24%) and found to be significantly higher at 1 year(p=0.009) but lost significance at subsequent follow-up (p=0.18).Among eyes which received glaucoma drainage implants (n=20), the1, 3, and 5-year survival rates were 63%, 26%, and 26%,respectively, in the eyes with anterior chamber implants (n=15)versus 100%, 100%, and 100%, respectively, in those with pars planaplacement (n=5, p=0.04).Conclusions: Though patients with pre-existing glaucoma had atrend towards higher graft survival in the PK compared to the DSEKgroup; this difference was not found to be statistically significant.Tube placement in the anterior chamber is a significant risk factor forgraft failure.Commercial Relationships: George C. Papachristou, None; DavidS. Greenfield, National Eye Institute (R), Carl Zeiss Meditec (R),Optovue (R), Heidelberg Engineering (R), Allergan (C), Alcon (C),Merz (C), Quark (C), SOLX (C), Biometric Imaging (C), Senju (C);Terrence P. O'Brien, None; Joyce C. Schiffman, None; Wei Shi,None; Shawn M. Iverson, NoneSupport: P30EY014801 University of Miami Core Grant: AnUnrestricted Grant from Research to Prevent Blindness, New York,New YorkProgram Number: 3075 Poster Board Number: D0010Presentation Time: 8:30 AM - 10:15 AMSelf-retained amniotic membrane for high-risk penetratingkeratoplasty - one-year resultsPho Nguyen 1 , Ramya N. Swamy 1 , Kelly Rue 1 , J M. Heur 1 , Samuel C.Yiu 2, 3 . 1 Doheny Eye Inst, USC / Keck School of Medicine, LosAngeles, CA; 2 Wilmer Eye Inst, Johns Hopkins Univ, Baltimore,MD; 3 King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.Purpose: To evaluate the role of self-retained cryopreserved humanamniotic membrane (hAM) in penetrating keratoplasty (PKP) graftsurvival.Methods: A retrospective noncomparative interventional case seriesof 58 cases of high-risk PKP with concurrent placement of a selfretainedcryopreserved hAM device (ProKera®) at a tertiary eyecenter from January 2009 to July 2010. Outcome measure was graftsurvival. All surgeries were performed by one surgeon (SCY).Results: Average age was 66.7 ± 17.2 years and 54% were males. 51eye were pseudophakic and one aphakic. 27 eyes were glaucomatous;24 of these had glaucoma drainage implants and 2 hadendocyclophotocoagulation performed. 12 patients had PKP for thefirst time and 46 had repeat PKP (average number of prior PKP 1.63± 1.1, range: 1-5). High-risk factors included repeat PKP (79.3%),corneal neovascularization (51.7%), preexisting glaucoma (46.6%),and anterior synechiae (37.9%). Both First Transplant and RepeatTransplant groups had similar survival rates until 6 months aftertransplant. At year 1, the First Transplant group appeared to havebetter survival (67%), compared to that of the Repeat Transplant(43%). This advantage, however, did not reach statistical significance(hazard ratio 0.562, log-rank test p = 0.207). Eyes with 3+ high-riskfactors had higher failure (odds ratio = 5.81, p = 0.003).Conclusions: Compared to literature, the benefits of hAM inprolongation of graft survival were indeterminate in our study.However, this study has many limitations, e.g. retrospective study ofa high-risk population with lack of control and many confounders.Further studies are recommended to provide definitive information onobjective and subjective outcomes.Commercial Relationships: Pho Nguyen, None; Ramya N.Swamy, None; Kelly Rue, None; J M. Heur, None; Samuel C. Yiu,NoneSupport: NEI core grant EY03040 and an unrestricted grant fromResearch to Prevent Blindness. Pho Nguyen is supported by the HeedOphthalmic Foundation and the Fletcher Jones Foundation.Program Number: 3076 Poster Board Number: D0011Presentation Time: 8:30 AM - 10:15 AMAnterior Chamber Depth and Penetrating Keratoplasty GraftSurvivalChristine N. Pham Lagler, Wuqaas M. Munir. Ophthalmology,Boston University School of Medicine, Boston Medical Center,Boston, MA.Purpose: To examine the association between pre-operative anteriorchamber depth (ACD) and penetrating keratoplasty graft survival inpatients with prior or concomitant intraocular lens placement.Methods: This retrospective study examined cases of penetratingkeratoplasty with prior or concomitant intraocular lens placementperformed by a single surgeon (WMM) between 2006 and 2011.Cases with missing ACD measurements or immediate post-operativegraft complications were excluded. Logistic regression analysis wasthen performed to determine if there was a statistically significant©2013, Copyright by the Association for Research in Vision and Ophthalmology, Inc., all rights reserved. Go to iovs.org to access the version of record. For permissionto reproduce any abstract, contact the ARVO Office at arvo@arvo.org.