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Cornea transplantation indications, considerations, and outcomes in the tenth decade of life
Free Paper Details
First Author: H.Levine USA
Co Author(s): A. Naranjo D. Altamirano F. Mohder T. O'Brien J. Martinez Martinez G. Amescua
Abstract Details
Purpose:
Life expectancy has increased considerably in the last decade and the number of patients over the age of 90 years is expected to increase as well. Corneal opacities are among the most common causes of blindness worldwide. Decreased vision is associated with a higher fall risk in the elderly population. Despite this, there is limited evidence on outcomes of cornea transplantation in this population. The purpose of this study was to report the ophthalmic and anesthetic indications, considerations, and outcomes in cornea transplantation in patients over 90-years-old.
Setting:
The study was conducted at the Bascom Palmer Eye Institute in Miami FL, US, between 1/1/2013 and 10/1/2020. Patients were selected from a specimen database from the Florida Lions Eye Bank
Methods:
Retrospective chart review of 58 eyes of 52 consecutive patients. Inclusion criteria was: 1) ≥90 years at time of surgery 2) ≥3 months post-op follow-up. For eyes with more than one surgery, only the last case was considered. Information regarding demographics, medical and ocular comorbidities, indications for surgery, type of surgery, anesthesia applied, complications and progression of best corrected visual acuity (BCVA) in LogMAR were collected and analyzed. A Kaplan-Meier survival curve was performed. Graft survival was calculated from the date of the surgery to the last date of follow-up or to the date of failure or rejection.
Results:
Mean age was 92±2 years; 27% were male, 85% self-identified as white and 39% as Hispanic. Hypertension (81%), arthritis (62%) and Hyperlipidemia (40%) were common systemic comorbidities. Ocular comorbidities included: glaucoma (62%), AMD (24%) and prior corneal transplant (36%). Indications for surgery included Pseudophakic bullous keratopathy (29%), Fuchs endothelial dystrophy (21%), perforated corneal ulcer (19%). Surgeries performed were Penetrating keratoplasty (43%), DSAEK (48%), Keratoprosthesis (7%). Concomitant interventions were needed in 60% of cases. There were no anesthetic complications. BCVA improved -0.27±0.70, p<0.001 at 3 months and -0.45±0.70, p<0.001 at 12 months. Graft survival at 12 months was 88%.
Conclusions:
Special considerations must be taken into account when treating elderly patients. In our experience, corneal transplantation can be considered a safe procedure for patients over 90-year-old with significant improvement in visual acuity and graft survival of 88% at 12 months. Further research is needed to evaluate the impact of cornea transplantation in quality of life in this population.
Financial Disclosure:
