Purpose: 

The purpose of this study was to report the indications, ocular and systemic comorbidities, and surgical outcomes of corneal transplantation in patients older than 90 years.

Methods: 

A retrospective review was conducted to identify individuals 90 years and older who underwent corneal transplantation surgery at the Bascom Palmer Eye Institute between January 2013 and October 2020. Outcomes included best-corrected visual acuity and graft survival over time. Paired t tests were used to compare visual acuity preoperatively versus postoperatively. Graft survival was evaluated with Kaplan–Meier curves.

Results: 

Fifty-eight eyes of 52 consecutive individuals were included. The mean age of individuals was 92 ± 2 years; 26.9% were male; and 48.1% self-identified as non-Hispanic White and 38.5% as Hispanic. Postoperative follow-up was 14.7 ± 12.1 months. Of the 58 eyes, 44.8% (26/58) underwent penetrating keratoplasty, 46.6% (27/58) Descemet stripping automated endothelial keratoplasty, and 6.9% (4/58) keratoprosthesis. All surgeries were performed under monitored local anesthesia, without major complications. Surgical indications included pseudophakic bullous keratopathy (36.2%), glaucoma-associated corneal decompensation (27.6%), Fuchs endothelial dystrophy (25.9%), and perforated corneal ulceration (19.0%). The best-corrected visual acuity improved by 0.32 (95% confidence interval 0.14–0.50; P < 0.01) as early as 1 month postoperatively, and vision gains were sustained for at least 12 months. Graft survival probability at 12 months was 88%.

Conclusions: 

Corneal transplantation is a safe and successful procedure in restoring the visual acuity for patients older than 90 years after careful preoperative evaluation. Further research is needed to evaluate the impact of corneal transplantation on quality of life in patients in the 10th decade of life.

中文翻译：

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十岁以上患者进行角膜手术的注意事项

目的： 

本研究的目的是报告 90 岁以上患者角膜移植的适应症、眼部和全身合并症以及手术结果。

方法： 

对 2013 年 1 月至 2020 年 10 月期间在 Bascom Palmer 眼科研究所接受角膜移植手术的 90 岁及以上患者进行了一项回顾性审查。结果包括随时间推移的最佳矫正视力和移植物存活率。使用配对t检验来比较术前与术后的视力。用卡普兰-迈耶曲线评估移植物存活率。

结果： 

包括 52 个连续个体的 58 只眼睛。个体的平均年龄为 92 ± 2 岁；26.9%为男性；48.1% 的人自认为是非西班牙裔白人，38.5% 的人自认为是西班牙裔。术后随访时间为 14.7 ± 12.1 个月。在58只眼睛中，44.8%（26/58）接受了穿透性角膜移植术，46.6%（27/58）接受了后弹力层剥离自动内皮角膜移植术，6.9%（4/58）接受了人工角膜移植术。所有手术均在局部麻醉监测下进行，没有出现重大并发症。手术适应症包括人工晶状体大疱性角膜病（36.2%）、青光眼相关角膜失代偿（27.6%）、Fuchs内皮营养不良（25.9%）和穿孔角膜溃疡（19.0%）。术后 1 个月，最佳矫正视力就提高了 0.32（95% 置信区间 0.14-0.50；P < 0.01），并且视力增益可持续至少 12 个月。12 个月时移植物存活率为 88%。

结论： 

经过仔细的术前评估后，角膜移植是恢复 90 岁以上患者视力的安全且成功的手术。需要进一步的研究来评估角膜移植对患者十岁时生活质量的影响。