New insights on why some corneal transplants fail, why some patients skip their glaucoma medications, and why preventing infections after LASIK is a growing concern are some of the major topics covered in the June issue of Ophthalmology, the journal of the American Academy of Ophthalmology.
Patients at Higher Risk for Corneal Transplant FailureResearchers analyzed data for 1,090 participants in the Cornea Donor Study (CDS), a multicenter, controlled clinical trial, to find factors linked with corneal transplant failure. The failure rate was about four times higher in patients diagnosed with corneal edema (swelling) associated with either intraocular lens (IOL) implants or no natural lens following cataract removal, than in patients diagnosed with Fuchs' dystrophy, a disorder of the corneal endothelial layer. Also, failure rates were substantially higher for glaucoma patients treated surgically, with medications, or both. These results, reported by Alan Sugar, M.D., for the CDS Investigator Group, were part of a five-year study funded by the National Eye Institute and coordinated by the Jaeb Center for Health Research, Tampa, Florida.
The 27 percent of patients diagnosed with IOL-associated corneal edema whose transplants failed may have shared an underlying problem: an abnormal reaction to cataract surgery and/or IOLs that negatively impacted the cornea in some way. (The vast majority of patients who have cataract-IOL surgery have no such reaction.) When these patients received new corneas, their underlying problem remained and compromised the transplant, the researchers suggest. In contrast, Fuchs' dystrophy patients had only a seven percent failure rate, including those who had IOLs. The failure rate for participants who did not have glaucoma was 11 percent versus failure rates of 20 percent, 29 percent and 58 percent for glaucoma patients treated with medications alone, surgery alone, or both, respectively.
