Search

PURPOSE: To determine the frequency of corneal regraft (CR) and to identify risk factors associated with CR for all primary diagnoses, secondary endothelial failure (SEF), and keratoconus. METHODS: This survey included 8904 eyes registered on the French national waiting list that underwent keratoplasty between 2000 and 2002. RESULTS: The frequency of CR was 14.0% for all diagnoses, 16.9% among SEF patients, and 8.3% among keratoconus patients. For all diagnoses, the following factors were found to be independently associated with a significantly increased risk of CR (P < 0.05): primary diagnosis (stromal dystrophy, herpes simplex keratitis, SEF, trauma, and keratoconus with Fuchs dystrophy as reference), vascularization in more than 2 quadrants, planned recipient diameter over 8.5 mm, immunologic disorders, previous lens surgery (aphakic, pseudophakic anterior or posterior chamber intraocular lens), previous surgery for glaucoma or trauma, being grafted in 2001 or in 2002. For SEF patients, the risk factors were younger age, vascularization in more than 2 quadrants, planned recipient diameter over 8.5 mm, immunologic disorders, previous surgery for glaucoma or trauma, associated cataract or dry eye, and graft year. For keratoconus patients, the risk factors for CR were older age, vascularization in more than 2 quadrants, immunologic disorders, and previous lens surgery. CONCLUSION: The frequency of CR increased in France over the 2000-2002 time period. Patients presenting the above risk factors should be followed up closely to limit the loss of the first graft.

PURPOSE To study the progress of cornea donation and transplantation in France. METHODS A questionnaire was sent, every year since 1994, to all the heads of ophthalmology departments in public and private hospitals. RESULTS Response rates of almost 100% were obtained each year. In 1997, 153 hospitals carried out cornea harvesting or transplantation. The number of cornea donations decreased sharply between 1991 (3,774) and 1993 (2,383). Donations then increased slowly to reach 3,591 in 1997 [60 per million population (pmp)]. Cornea-transplantation activity followed the same pattern, decreasing from 3,843 transplants in 1991 to 3,210 (54 pmp) in 1997. In 1997, 73% of cornea transplants took place in 90 public hospitals, and only 27% took place in 28 private hospitals. The number of imported corneas has increased, particularly in 1997, in which 764 corneas were imported (24% of the corneas transplanted). Ninety-two percent of imported corneas were grafted in private hospitals. The estimate of the number of patients registered on local waiting lists increased to 8,303 at the end of 1997. There was a weak correlation between the number of corneas transplanted and the number of patients on local waiting lists by hospital (r = 0.65; p < 0.0001). CONCLUSION The rate of corneal grafts in France is similar to that in other European countries, but the number of patients on waiting lists is high. Careful thought and effort should be applied to increasing the level of corneal donation and harvesting and reducing waiting lists in France to levels similar to those in other European countries.