Is there evidence for a surgeon learning curve for endothelial keratoplasty in Australia?

Expected outcomes from endokeratoplasty may vary with surgeon experience.It was explored whether a surgeon learning curve exists for Descemet stripping endothelial keratoplasties (manual or automated) performed in Australia.This is a prospective cohort study, with various clinical settings.There were 2139 recipients of 2615 endothelial grafts, registered by 85 surgeons between January 2006 and December 2013.Kaplan-Meier survival analyses and Cox proportional hazards regression were used to examine longitudinal graft survival. Manual and automated Descemet stripping endothelial keratoplasties were analysed together. Pearson chi-squared analyses were performed to examine differences amongst groups. Continuity correction was used for 2 × 2 tests, and statistical significance was set at P 0.05 (two-sided).The main parameter measured was endothelial graft survival.Survival of the first 56 registered grafts was significantly poorer than survival of subsequent grafts (χOur findings suggest that for less experienced or low-volume surgeons, longitudinal graft survival improved once 56 or more endokeratoplasties had been performed, indicative of a learning curve. The learning curve was less apparent for surgeons with 57 or more Descemet stripping endothelial keratoplasties and/or Descemet stripping automated endothelial keratoplasties registered during the 8-year study period. Different learning curves may be anticipated for these two groups of surgeons.