Outcome of primary adult optical penetrating keratoplasty in a public health service facility of a developing country

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dc.contributor.advisor Meyer, David en_ZA
dc.contributor.author Wagoner, Michael D. en_ZA
dc.contributor.other Stellenbosch University. Faculty of Health Sciences. Dept. of Surgical Sciences. Ophthalmology.
dc.date.accessioned 2008-10-14T14:06:17Z en_ZA
dc.date.accessioned 2010-06-01T08:13:05Z
dc.date.available 2008-10-14T14:06:17Z en_ZA
dc.date.available 2010-06-01T08:13:05Z
dc.date.issued 2008-12 en_ZA
dc.identifier.uri http://hdl.handle.net/10019.1/1126
dc.description Thesis (PhD (Surgical Sciences. Ophthalmology))--Stellenbosch University, 2008. en_ZA
dc.description.abstract Purpose: To evaluate the outcome of primary adult optical penetrating keratoplasty (PKP) at a public health service hospital of a developing country. Patients and Methods: A retrospective review was performed of the medical records of every patient 12 years of age or older who underwent PKP for keratoconus, corneal edema, stromal scarring, or stromal dystrophy at King Khaled Eye Specialist Hospital in the Kingdom of Saudi Arabia between January 1, 1997, and December 31, 2001, and for whom a minimum of 3 months’ follow-up was available. Results: Of 910 eyes that met the inclusion criteria, there were 464 eyes with keratoconus, 188 eyes with corneal edema, 175 eyes with stromal scarring, and 83 eyes with stromal dystrophy. For the entire group, the probability of graft survival was 96.7% at 1 year, 86.2% at 3 years, and 80.9% at 5 years. Five-year survival probability was best with keratoconus (96.1%), followed by stromal dystrophy (85.9%), stromal scarring (71.1%), and corneal edema (40.3%). The probability of graft survival differed significantly among the surgical indications at all postoperative intervals (P<0.001). Factors associated with a significantly increased risk of graft failure on multivariate Cox proportional hazard regression analysis included increasing donor tissue age (P = 0.005) and decreasing recipient graft size (P = 0.02). Final visual acuity of 20/40 or better was obtained in 409 (44.9%) eyes. Visual acuity of 20/40 or better was obtained in 336 (72.4%) eyes with keratoconus and in 53 (63.9%) eyes with stromal dystrophy but in only 11 (6.3%) eyes with stromal scarring and 9 (4.8%) eyes with corneal edema (P<0.001). Overall, improvement in vision occurred in 750 (82.4%) eyes, remained the same in 97 (10.7%) eyes, and worsened in 63 (6.9%) eyes. Conclusions: The present study has conclusively demonstrated that primary adult optical PKP can be performed at a public health facility in the Kingdom of Saudi Arabia with graft survival and visual results that are comparable to those obtained in welldeveloped Western facilities. This success is attributed to the presence of a suitable infrastructure that provides modern eye care facilities, donor tissue, and pharmaceuticals to patients who have access to preoperative screening and evaluation, surgical intervention, and postoperative care by well-trained ophthalmologists and ancillary support personnel. en_ZA
dc.language.iso en en_ZA
dc.publisher Stellenbosch : Stellenbosch University
dc.subject Optical penetrating keratoplasy en_ZA
dc.subject Developing country en_ZA
dc.subject Public health en_ZA
dc.subject Dissertations -- Ophthalmology en
dc.subject Theses -- Ophthalmology en
dc.title Outcome of primary adult optical penetrating keratoplasty in a public health service facility of a developing country en_ZA
dc.type Thesis en_ZA
dc.rights.holder Stellenbosch University
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