Changing trends in keratoplasty

Cost-effectiveness of Descemet stripping automated endothelial keratoplasty versus penetrating keratoplasty in patients with endothelial dysfunction in India

Purpose:

The aim of this study was to compare the cost-effectiveness and perform cost-utility analysis of Descemet stripping automated endothelial keratoplasty (DSAEK) vs. penetrating keratoplasty (PK) in Indian population.

Methods:

This was an institutional, ambispective, observational study. Patients who underwent PK or DSAEK for endothelial dysfunction were included and followed up for 2 years; those with other ocular comorbidities were excluded. The analysis was performed from the patient’s perspective receiving subsidized treatment at a tertiary care hospital. Detailed history, ophthalmic examination, total expenditure by patient, and clinical outcomes were recorded. The main outcome measures were best spectacle-corrected visual acuity (BSCVA), graft survival (Kaplan–Meier survival estimates), incremental cost-effectiveness ratio (ICER), and incremental cost-utility ratio (ICUR). Utility values were based on quality-adjusted life years (QALYs) associated with visual acuity outcomes. Statistical analysis was performed using SPSS software package, version 12.1; a value of P < 0.05 was considered statistically significant.

Results:

A total of 120 patients (PK: 60, DSAEK: 60) were included. At 2 years, for a similar logMAR BSCVA, [PK (0.32 ± 0.02), DSAEK (0.25 ± 0.02); P = 0.078], the overall cost for PK (13511.1 ± 803.3 INR) was significantly more than DSAEK (11092.9 ± 492.1 INR) (difference = 1952.6 INR; P = 0.01). ICER of DSAEK relative to PK was –39,052 INR for improvement in 1 logMAR unit BSCVA. ICUR of DSAEK relative to PK was –1,95,260 INR for improvement in 1 QALY.

Conclusion:

DSAEK was more cost-effective than PK in patients with endothelial dysfunction at 2 years.

Publication trends in corneal transplantation: a bibliometric analysis

Background

Our aim was to demonstrate the publication trends of corneal transplantation in the last decade.

Methods

All of the keratoplasty research articles, letters, case reports, reviews and meeting abstracts published between January 2006 and December 2015 indexed on the Thomson Reuters Web of Knowledge were evaluated. A bibliometric filter was used to capture keratoplasty related publications by using the key words ‘keratoplasty’, ‘corneal transplantation’ or ‘keratoprosthesis’ in the ‘title’ selection mode.

Results

A total of 2726 publications were evaluated in the present study. Documents related to penetrating keratoplasty only have been decreased, whereas the documents related to endothelial keratoplasty were increased in the last decade. The total keratoplasty publication counts had been increased from the year 2006 to 2015. The average citation count per keratoplasty documents was 9.34.

Conclusions

There is a growing interest to the lamellar keratoplasty techniques especially the endothelial keratoplasty in the last decade.

Comparison of proliferative capacity of genetically-engineered pig and human corneal endothelial cells

PURPOSE

The possibility of providing cultured corneal endothelial cells (CECs) for clinical transplantation has gained much attention. However, the worldwide need for human (h) donor corneas far exceeds supply. The pig (p) might provide an alternative source. The aim of this study was to compare the proliferative capacity of CECs from wild-type (WT) pigs, genetically-engineered (GE) pigs, and humans.

METHODS

The following CECs were cultured: hCECs from donors (i) ≤36 years (young), (ii) ≥49 years (old), and WT pCECs from (iii) neonatal (<5 days), (iv) young (<2 months), and (v) old (>20 months) pigs, and CECs from young (vi) GE pigs (GTKO/CD46 and GTKO/CD46/CD55). Proliferative capacity of CECs was assessed by direct cell counting over 15 days of culture and by BrdU assay. Cell viability during culture was assessed by annexin V staining. The MTT assay assessed cell metabolic activity.

RESULTS

There was significantly lower proliferative capacity of old CECs than of young CECs (p < 0.01) in both pigs and humans. There was no significant difference in proliferative capacity/metabolic activity between young pCECs and young hCECs. However, there was a significantly higher percentage of cell death in hCECs compared to pCECs during culture (p < 0.01). Young GE pCECs showed similar proliferative capacity/cell viability/metabolic activity to young WT pCECs.

CONCLUSIONS

Because of the greater availability of young pigs and the excellent proliferative capacity of cultured GE pCECs, GE pigs could provide a source of CECs for clinical transplantation.