TRANSPLANT DATA, 2004-2009 .1 Recipient Data

10 Table 2.3.1.3: Pre-operative Vision, 2004-2009 Year 2004 N=138 2005 N=192 2006 N=177 2007 N=196 2008 N=231 2009 N=209 TOTAL N=1143 Unaided VA No. No. No. No. No. No. No. 66 3 2 0 0 1 1 1 1 1 1 1 1 7 1 69 1 1 1 1 1 1 2 1 6 2 2 1 13 1 612 0 0 2 1 3 1 0 0 2 1 2 1 9 1 618 0 0 1 1 0 0 2 1 1 1 3 1 7 1 624 3 2 5 2 4 2 2 1 3 1 4 2 21 2 636 4 3 6 3 5 3 3 1 6 2 6 3 30 3 660 7 5 16 8 17 10 11 5 14 6 17 8 82 7 560 1 1 0 0 0 0 0 0 0 0 0 0 1 0 460 3 2 1 1 2 1 2 1 0 0 0 0 8 1 360 2 1 2 1 1 1 4 2 5 2 5 2 19 2 260 1 1 2 1 4 2 1 1 2 1 4 2 14 1 160 4 3 9 4 7 4 2 1 1 1 6 3 29 2 CF 47 34 47 24 45 25 43 22 40 17 70 33 292 25 HM 47 34 46 24 37 21 48 24 48 21 55 26 281 24 PL 13 10 15 8 12 7 17 9 20 9 15 7 92 8 NPL 2 1 1 1 0 0 1 1 0 0 1 1 5 1 Others 0 0 0 0 0 0 0 0 0 0 1 1 1 0 No data 0 0 38 20 38 21 57 29 82 35 17 8 232 20 11 CORNEAL TRANSPLANTATION 2.3.2: Donor details Eye Banks in the United States of America USA were the most frequent source of the corneal tissues Table 2.3.2.1. The majority of donors were elderly patients with a median age of 59 years Table 2.3.2.2. Optisol GS was the commonest corneal tissue storage medium used at 76 Table 2.3.2.3. The major cause of death of the donors were related to the cardiaccirculatory system 30 followed by malignancy 15 Table 2.3.2.4. Table 2.3.2.1: Source of Donor Cornea Tissue, 2004-2009 Year 2004 N=138 2005 N=192 2006 N=177 2007 N=196 2008 N=231 2009 N=209 TOTAL N=1143 Source of donor No. No. No. No. No. No. No. Local 20 14 19 10 36 20 31 16 41 18 41 20 188 16 USA 95 69 133 69 98 56 114 58 150 65 130 62 720 63 Sri Lanka 22 16 38 20 41 23 51 26 37 16 38 18 227 19 Others 0 0 0 0 2 1 0 0 2 1 0 0 4 1 No data 1 1 2 1 0 0 0 0 1 0 0 0 4 1 If Local, ethnic group: x Malay 0 0 4 21 1 3 5 16 0 0 0 0 10 5 x Chinese 14 70 8 42 12 33 16 52 22 54 29 71 101 54 x Indian 5 25 7 37 23 64 4 13 9 22 12 29 60 32 x Others 0 0 0 0 0 0 4 13 10 24 0 0 14 7 x Unknown 1 5 0 0 0 0 2 6 0 0 0 0 3 2 In the year 2004 there were a total of 184 corneal transplants performed but complete data set was only received for 138 patients. Figure 2.3.2.1: Source of Donor Corneal Tissue, 2004-2009 Perce n t Year 10 20 30 40 50 60 70 Local USA Sri Lanka Others 2004 2005 2006 2007 2008 2009 12 Table 2.3.2.2: Donor Age Distribution, 2004-2009 Year 2004 N=138 2005 N=192 2006 N=177 2007 N=196 2008 N=231 2009 N=209 TOTAL N=1143 Age group years No. No. No. No. No. No. No. 0-9 2 2 3 2 2 1 2 1 7 3 2 1 18 2 10-19 6 4 4 2 9 5 5 3 7 3 9 4 40 3 20-39 11 8 7 4 11 6 13 7 19 8 17 8 78 7 40-59 51 37 89 46 81 46 83 42 80 35 85 41 469 41 60 68 49 89 46 74 42 93 47 118 51 96 46 538 47 Mean 57 58 56 57 56 56 57 SD 15 14 16 14 17 16 15 Median 59 58 56 59 60 58 59 Minimum 8 3 6 4 1 1 1 Maximum 78 79 78 78 76 77 79 Table 2.3.2.3: Preservation Media, 2004-2009 Year 2004 N=138 2005 N=192 2006 N=177 2007 N=196 2008 N=231 2009 N=209 TOTAL N=1143 Preservation media No. No. No. No. No. No. No. Optisol GS 90 65 145 75 128 72 134 68 189 82 183 88 869 76 MK Medium 22 16 37 19 40 23 51 26 35 15 15 7 200 17 Moist Chamber 4 3 3 2 7 4 8 4 4 2 8 4 34 3 Others 0 0 1 1 0 0 3 2 1 0 0 0 5 1 No data 22 16 6 3 2 1 0 0 2 1 3 1 35 3 Others specify Eusol-C Figure 2.3.2.3: Preservation Media, 2004-2009 Perce nt Year 10 20 30 40 50 60 70 80 Optisol MK Medium Moist Chamber 2004 2005 2006 2007 2008 2009 13 CORNEAL TRANSPLANTATION Table 2.3.2.4: Cause of Death in Corneal Donors, 2004-2009 Year 2004 N=138 2005 N=192 2006 N=177 2007 N=196 2008 N=231 2009 N=209 TOTAL N=1143 Cause of death No. No. No. No. No. No. No. Cardiac Circulatory System 47 34 49 26 59 33 75 38 61 26 58 28 349 30 Cerebrovascular System 17 12 25 13 11 6 23 12 35 15 18 9 129 11 Malignancy 19 14 31 16 25 14 26 13 41 18 27 13 169 15 Trauma Accident 20 15 13 7 19 11 24 12 21 9 28 13 125 11 Respiratory System 15 11 8 4 8 5 13 7 10 4 25 12 79 7 Others 17 12 21 11 27 15 32 16 59 26 49 23 205 18 No data 3 2 45 23 28 16 3 2 4 2 4 2 87 8 2.3.3: Transplant Practices Penetrating Keratoplasty PK was the commonest type of surgery performed 86 Table 2.3.3.1. Corneal transplantation was performed in combination with other surgical procedures in 18 of cases. Cataract extraction, with or without intraocular lens implantation IOL, was the commonest combined procedure Table 2.3.3.2.The recipient graft size ranged from 2mm to 10mm, with the median recipient cornea graft size being 7.5mm.Table 2.3.3.3. The majority of cases had the donor tissue over-sized by 0.5mm Table 2.3.3.4. The commonest suturing technique was interrupted sutures Table 2.3.3.5. Table 2.3.3.1: Types of Surgeries, 2004-2009 Year 2004 N=138 2005 N=192 2006 N=177 2007 N=196 2008 N=231 2009 N=209 TOTAL N=1143 Type of surgery No. No. No. No. No. No. No. Penetrating Keratoplasty 120 87 173 90 153 86 175 89 189 82 173 82 983 86 Lamellar Keratoplasty 10 7 13 7 16 9 7 4 21 9 15 7 82 7 Patch Graft for Corneal 2 2 3 1 5 3 10 5 12 5 9 4 41 4 Patch Graft for Scleral 0 0 1 1 0 0 0 0 2 1 1 1 4 0 Cornea Scleral Keratoplasty 6 4 2 1 3 2 4 2 4 2 10 5 29 3 Endothelial keratoplasty 0 0 0 0 0 0 0 0 3 1 0 0 3 0 Others 0 0 0 0 0 0 0 0 0 0 1 1 1 0 In the year 2004 there were a total of 184 corneal transplants performed but complete data set was only received for 138 patients. Table 2.3.3.2: Types of Combined Surgeries, 2004-2009 Year 2004 N=138 2005 N=192 2006 N=177 2007 N=196 2008 N=231 2009 N=209 TOTAL N=1143 Combined surgeries No. No. No. No. No. No. No. No. of patients with corneal transplant surgery combined with another surgical procedure 30 22 27 14 41 23 35 18 46 20 32 15 211 18 a Glaucoma surgery 2 7 3 11 1 2 0 0 3 7 2 6 11 5 b Cataract Extraction 15 50 13 48 21 51 13 37 17 37 15 47 94 45 c IOL 13 43 10 37 24 59 19 54 23 50 10 31 99 47 d Cataract extraction and IOL 9 30 8 30 15 37 10 29 16 35 9 28 67 32 e Retinal Surgery + Internal Tamponade 1 3 1 4 2 5 4 11 10 22 0 0 18 9 f Anterior vitrectomy 9 30 3 11 4 10 10 29 6 13 9 28 41 19 g Others 5 17 8 30 8 20 16 46 14 30 11 34 62 29 Patients may have more than one combined surgery. 14 Table 2.3.3.3: Recipient Cornea Trephine Size, 2004-2009 Year 2004 N=138 2005 N=192 2006 N=177 2007 N=196 2008 N=231 2009 N=209 TOTAL N=1143 Graft size, mm No. No. No. No. No. No. No. 2 1 1 1 1 2 1 1 1 0 0 1 1 6 1 3 0 0 1 1 2 1 1 1 1 1 2 1 7 1 4 1 1 2 1 1 1 5 2 2 1 1 1 12 1 5 0 0 0 0 0 0 1 1 1 0 1 1 3 1 5.5 1 1 0 0 0 0 0 0 0 0 0 0 1 0 6 3 2 0 0 5 3 4 2 4 1 7 3 23 2 6.25 0 0 1 1 0 0 0 0 0 0 0 0 1 0 6.5 2 1 5 2 4 2 8 4 7 3 9 4 35 3 6.7 0 0 0 0 0 0 0 0 1 1 0 0 1 0 6.75 1 1 3 1 2 1 1 1 1 1 2 1 10 1 7 25 18 36 19 25 14 29 15 38 16 35 16 188 16 7.2 1 1 0 0 0 0 0 0 1 1 0 0 2 0 7.25 9 7 10 5 14 8 5 2 5 2 10 5 53 5 7.5 36 26 18 9 26 15 37 19 50 21 33 16 200 17 7.75 8 5 11 6 6 3 12 6 14 6 47 22 98 8 7.8 2 1 0 0 0 0 0 0 0 0 0 0 2 0 8 18 13 7 4 13 7 19 10 26 11 25 12 108 9 8.15 0 0 0 0 0 0 0 0 1 1 0 0 1 0 8.25 4 3 4 2 5 3 4 2 4 2 4 2 25 2 8.5 6 4 6 3 2 1 11 5 10 4 5 2 40 3 8.75 0 0 1 1 0 0 0 0 0 0 0 0 1 0 9 9 7 3 1 1 1 4 2 3 1 6 3 26 2 9.5 0 0 2 1 0 0 0 0 1 0 2 1 5 1 10 1 1 0 0 0 0 0 0 2 1 3 1 6 1 10.5 0 0 0 0 0 0 0 0 0 0 1 1 1 0 11 0 0 0 0 0 0 0 0 1 1 2 1 3 1 12 0 0 0 0 0 0 0 0 1 1 0 0 1 0 No data 10 7 81 42 69 39 54 27 57 24 13 6 284 25 Mean 7.5 7.3 7.2 7.3 7.5 7.5 7.4 SD 0.9 1 1.1 1.1 0.9 1 1 Median 7.5 7.3 7.3 7.5 7.5 7.5 7.5 Minimum 2 2 2 2 3 2 2 Maximum 10 9.5 9 9 12 11 12 15 CORNEAL TRANSPLANTATION Table 2.3.3.4: Difference in Trephined Sizes of Recipient and Donor Corneas, 2004- 2009 Year 2004 N=138 2005 N=192 2006 N=177 2007 N=196 2008 N=231 2009 N=209 TOTAL N=1143 Difference in Graft size, mm No. No. No. No. No. No. No. Same Size 9 6 8 4 8 4 12 6 19 8 51 24 107 9 0.2 2 1 0 0 0 0 0 0 2 1 0 0 4 0 0.25 22 16 19 10 30 17 27 14 27 12 36 17 161 14 0.3 5 4 0 0 0 0 0 0 0 0 1 1 6 1 0.4 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0.5 86 62 84 44 67 38 95 48 117 51 99 47 548 48 0.55 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0.6 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0.75 0 0 0 0 1 1 1 1 2 1 1 1 5 1 0.8 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 1 1 4 2 2 1 5 2 13 1 1.5 0 0 0 0 0 0 0 0 1 0 1 1 2 0 2 1 1 0 0 0 0 0 0 0 0 0 0 1 0 Not Available 10 7 81 42 70 39 57 29 59 26 15 7 292 26 Table 2.3.3.5: Suture Technique, 2004-2009 Year 2004 N=138 2005 N=192 2006 N=177 2007 N=196 2008 N=231 2009 N=209 TOTAL N=1143 Suture Technique No. No. No. No. No. No. No. Interrupted only 132 96 139 73 124 70 138 70 171 74 175 84 879 77 Continuous only 0 0 0 0 5 3 1 1 6 3 7 3 19 2 Combined 6 4 18 9 18 10 12 6 10 4 25 12 89 8 No data 0 0 35 18 30 17 45 23 44 19 2 1 156 13 16 2.4 CORNEAL TRANSPLANT OUTCOME 2004-2009 Table 2.4.1: Stock and Flow - Graft Status Whole Database Optical Non optical Total No. No. No. Number registered 810 68 379 32 1189 100 Number followed Total 327 156 483 1 year 201 62 121 78 322 67 2 year 70 21 24 15 94 19 3 year 42 13 7 5 49 10 4 year 10 3 4 2 14 3 5year 4 1 0 0 4 1 Graft status Total 327 156 483 -Surviving graft 260 80 84 54 344 71 -Failed graft 67 20 72 46 139 29 Recipient status Total 810 379 1189 -Recipient with complete follow up 99 12 78 20 177 15 -Recipient deaths 3 0 1 0 4 -Recipient loss - followed 224 28 77 21 301 25 -Recipient loss - not followed 374 46 124 33 499 42 -Graft not yet followed Transplant duration less than 1 year 110 14 99 26 209 18 17 CORNEAL TRANSPLANTATION 2.4.2 Outcome – Graft Survival 2004-2009 Graft survival for both optical and non-optical indications at 12 months was 77.2 but this declined to 64.5 at 36 months Table 2.4.2.1. The cases were grouped into two groups based on the indication for surgery – i Optical and ii Non-Optical. Graft survival was 86.8 at 12 months in the optical group and 57.1 in the non-optical group. This declined to 72.3 at 36 months in the optical group and 48.5 in the non- optical group Table 2.4.2.2. Primary graft failure was the commonest cause of graft failure.Table 2.4.2.5. Table 2.4.2.1: Graft Survival, 2004-2009 Interval months No. success SE 0 483 100 - 12 375 77.2 2 24 161 70.4 2 36 67 64.5 3 48 18 53. 4 6 60 4 47.5 8 Figure 2.4.2.1: Graft Survival, 2004-2009 0.00 0.20 0.40 0.60 0.80 1.00 Cu mu lativ e su rv iv al 12 24 36 48 60 Duration in months