Objective: To determine whether the 10-year success rate of penetrating keratoplasty for corneal endothelial disorders is associated with donor age.Design: Multicenter, prospective, double-masked clinical trial.Participants: A total of 1090 participants undergoing penetrating keratoplasty at 80 sites for Fuchs’ dystrophy (62%), pseudophakic/aphakic corneal edema (34%), or another corneal endothelial disorder (4%) and followed for up to 12 years.Methods: Forty-three eye banks provided corneas from donors aged 12 to 75 years, using a randomized approach to assign donor corneas to study participants without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons’ usual routines.Main Outcome Measures: Graft failure defined as a regraft or, in the absence of a regraft, a cloudy cornea that was sufficiently opaque to compromise vision for 3 consecutive months.Results: In the primary analysis, the 10-year success rate was 77% for 707 corneas from donors aged 12 to 65 years compared with 71% for 383 donors aged 66 to 75 years (difference, +6%; 95% confidence interval, −1 to +12; P = 0.11). When analyzed as a continuous variable, higher donor age was associated with lower graft success beyond the first 5 years (P < 0.001). Exploring this association further, we observed that the 10-year success rate was relatively constant for donors aged 34 to 71 years (75%). The success rate was higher for 80 donors aged 12 to 33 years (96%) and lower for 130 donors aged 72 to 75 years (62%). The relative decrease in the success rate with donor ages 72 to 75 years was not observed until after year 6.Conclusions: Although the primary analysis did not show a significant difference in 10-year success rates comparing donor ages 12 to 65 years and 66 to 75 years, there was evidence of a donor age effect at the extremes of the age range. Because we observed a fairly constant 10-year success rate for donors aged 34 to 71 years, which account for approximately 75% of corneas in the United States available for transplant, the Cornea Donor Study results indicate that donor age is not an important factor in most penetrating keratoplasties for endothelial disease.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Category: Peer-reviewed
How Will the Next Accreditation System Affect Ophthalmology Residency Training?
Years ago, imagine a co-resident who demonstrated suboptimal surgical skills early in residency. In some programs, this person would have received extra attention to bring his or her performance up to a passable level of competence. In others, the resi…
Erratum
With apologies from the author, in the article entitled, “Combination Therapy for Neovascular Age-related Macular Degeneration Refractory to Anti-Vascular Endothelial Growth Factor Agents” by Kevin Tozer, MD, A. Brock Roller, MD, Lawrence P. Chong,…
Secukinumab in the Treatment of Noninfectious Uveitis
We read with interest the article by Dick et al on the efficacy and safety of different doses of secukinumab in patients with noninfectious uveitis in 3 multicenter, randomized, double-masked, placebo-controlled, dose-ranging, phase III studies in the…
Erratum
Please note that one of the authors’ degrees in the publication entitled, “Lessons in Corneal Structure and Mechanics to Guide the Corneal Surgeon” (Ophthalmology 2013;120:1715-1717) had errors. The correct degrees for Dr. Jan P.G. Bergmanson shoul…
This Issue At A Glance
Young et al (p. 2390) compared the long-term outcome of limbal conjunctival autograft (LCAU) with that of intraoperative applications of mitomycin C (MMC) in minimizing pterygium recurrence. They also evaluated the effects of MMC on corneal endothelia…
Author reply
We appreciate Suelves, Gregori, and Diaz-Llopis’ interest in our recent article “A National Survey of Practice Patterns: Temporal Artery Biopsy.” In this study, we surveyed neuro-ophthalmologists, oculoplastic surgeons, and rheumatologists regarding temporal artery biopsy practices in the assessment of patients suspected to have giant cell arteritis (GCA). Specifically, we questioned practitioners as to whether they favored unilateral or bilateral temporal artery biopsy and their thoughts regarding the effect of prior corticosteroid therapy on biopsy findings. In short, responses varied greatly within and between specialists. Of slightly >1000 respondents, 37% recommended unilateral biopsy alone, 29% recommended initial unilateral biopsy with biopsy of the contralateral side if the first side is negative, 18% recommended bilateral biopsy in all cases, and 16% stated that their preference depended on the degree of suspicion. Most respondents believed that biopsies remained accurate for >14 days after initiating steroid therapy.
Cataract Surgery Cost Utility Revisited in 2012: A New Economic Paradigm
Objective: To assess the 2012 cost utility of cataract surgery in the United States and to compare 2012 cost-utility data with those from 2000.Design: Value-Based Medicine (Flourtown, PA), patient preference-based, comparative effectiveness analysis a…
Erratum
With apologies from the authors, in the publication entitled, “Dominant optic atrophy: Novel OPA1 mutations and revised prevalence estimates” (Ophthalmology 2013;120:1712.e1) had errors.
A Simple Vista en Este Número
Young y otros (p. 2390), compararon el resultado a largo plazo del autoinjerto limbal conjuntival (LCAU) con el de la aplicación de mitomicina C (MMC) para minimizar la recurrencia del pterigio. Evaluaron también los efectos de la MMC en la densidad …
Temporal Artery Biopsy
The recent article describing the clinical practice patterns for temporal artery biopsy as a mean of diagnosing giant cell arteritis (GCA) by Schallhorn et al provides important data that can inform the current practice. This article evaluated the pre…
Corneal Hysteresis and Glaucoma Progression
We read with interest the paper by Medeiros et al entitled “Corneal Hysteresis as a Risk Factor for Glaucoma Progression: A Prospective Longitudinal Study.” Although we applaud the utilization of longitudinal visual field analysis within that stud…
Is Carotid Ultrasound Necessary in the Evaluation of the Asymptomatic Hollenhorst Plaque?
Hollenhorst plaques are cholesterol emboli deposited within retinal arterioles. A few studies have evaluated the relationship between Hollenhorst plaques and surgically correctable carotid disease. For patients with Hollenhorst plaques and symptoms of …
期刊一览
Young (p. 2390) 等人对角结膜缘自体结膜移植术(LCAU)及术中使用丝裂霉素C对减少翼状胬肉复发的长期疗效进行了比较。他们也评估了丝裂霉素C对角膜内皮细胞密度(ECD)的影响。在随机、对照试验
Dexamethasone Intravitreal Implant Trapped at the Macula in a Silicone Oil-filled Eye
The Ozurdex (dexamethasone 0.7 mg) sustained-release intravitreal implant (Allergan Inc., Irvine, CA) is approved by the US Food and Drug Administration for treatment of adults with macular edema after retinal vein occlusions and with noninfectious pos…
Cost-Utility of Cataract Surgery: The Real Issues
The cost-utility study of cataract surgery by Brown et al shows off the authors’ high degree of skill in conducting analyses of this type. Readers do not have to be concerned that the extremely favorable results on cataract surgery will be doubted bec…
Contents
Scientific Reviewers
Evidence-Based Ophthalmology
It is easy to assume that colleagues are familiar with the structure and function of the international Cochrane Collaboration (List of contributors to CEVG available at http://aaojournal.org), but often this is off the mark or their understanding is misinformed. The Collaboration consists of >30 000 persons around the world who are committed to responding to Archie Cochrane’s challenge to the medical world in 1979:It is surely a great criticism of our profession that we have not organized a critical summary, by specialty or subspecialty, adapted periodically, of all relevant randomized controlled trials.
Author reply
Sullivan-Mee et al questioned whether our longitudinal results demonstrating a relationship between lower corneal hysteresis (CH) and faster progression in glaucoma could perhaps be confounded by a relationship between CH and disease severity. They su…