Penetrating Keratoplasty in Kenya: A Review of Indications and Outcomes over a 2-year period.
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Status: 
Ongoing

ABSTRACT

Purpose: To document the indications for and outcomes of penetrating keratoplasty-only surgeries in Kenya over a 2-year period.

Methods: A retrospective case series review of 174 eligible penetrating keratoplasties performed in 6 different facilities in Kenya from January 2001 to December 2011 was undertaken. Univariate and multivariate analyses were done. Corneal graft survival probabilities were determined using the Kaplan-Meier method.

Main Outcome Measures: Primary outcome measure was the proportion of corneal grafts that remained clear at the end of the follow-up period. Secondary outcome measures were final visual acuity, complications, and predictors of poor outcome.

Results: Keratoconus was the commonest indication accounting for 48.8% followed by bullous keratopathy at 18.4%. Pre-operatively, 66.7% of the eyes were blind with visual acuities <3/60. Corneal epithelial defect (43.5%) was the commonest early complication followed by corneal oedema (25.2%); persistent corneal oedema was the commonest late postoperative complication. At 24 months, 82.2% of the grafts remained clear while 17.8% (n=31) were not clear; only 8.24% of keratoconus grafts failed while 26.97% from other indications failed (relative risk= 3.2745, [95% CI 1.4895 - 7.1986], p<0.0012). Postoperatively, 71.82% of all grafts had final uncorrected vision of 6/60 or better, while 16.67% of grafts remained blind. Thirty-one (17.82%) grafts failed, of which 25.8% were due to primary graft failure and 74.2% were due to secondary graft failure. Survival probabilities at 24 months showed 90% of keratoconus grafts survived while 68% for the other indications survived with p< 0.0068. Poor predictors of corneal graft outcome were: bullous keratopathy (p<0.0019), postoperative glaucoma (p<0.0023), infection (p<0.0001), and persistent corneal oedema (p<0.0001). Contemporary causes of corneal blindness in Africa such as vitamin A deficiency and trachomatous corneal blindness were not encountered.

Conclusions: Keratoconus remains the leading indication for corneal grafts in Kenya. Overall corneal graft survival has improved, especially for corneal dystrophies and keratoconus. These findings are similar to results from industrialised countries. Poor predictors of graft outcome were corneal ulcers, herpes simplex keratitis, corneal graft glaucoma, and corneal graft oedema. Our findings suggest most corneal grafts in this part of Africa could attain longer graft survivals as well as better visual outcomes.

Key Words: Penetrating Keratoplasty, Indications, Visual Outcome, Survival, Risk Factors, Poor Predictors.

Collaborators: 

DR HYDARA ABBA

PROF DUNERA ILAKO

PROF DAN KIAGE

DR SHEILA MARCO

Start Month: 
August
Start Year: 
2011
End Month: 
December
End Year: 
2012