Penetrating keratoplasty in eThekwini Health District 2011–2014

Abstract

Background: Penetrating keratoplasty (PK – corneal transplantation or full-thickness corneal graft) remains the primary sight-restoring procedure for corneal blindness. South Africa is experiencing a shortage of donor corneas, resulting in long waiting times for a corneal transplant. A corneal graft protocol has been drawn up in the eThekwini Health District to triage prospective corneal graft recipients. Aim: To describe the clinical and demographic profiles of patients on the elective corneal graft waiting list, the waiting time for PK and the scoring system prioritisation process of corneal graft allocation. Setting: All patients on the elective corneal graft waiting list in the eThekwini Health District. Methods: An observational, descriptive cross-sectional study was conducted for a 3-year period between April 2011 and March 2014. Results: A total of 104 patients were on the elective corneal graft waiting list for PK during the study period. Only 20% (n = 21) of patients received a corneal graft during the 3-year period. Amongst those that received a corneal graft, the median waiting period was 280 days (interquartile range 143–520 days). The majority of patients on the waiting list (67%) were younger than 41 years of age. The commonest indication for PK was keratoconus (64%). Patients with higher pro forma scores are more likely to receive a corneal graft when a donor cornea becomes available. Conclusion: With a shortage of donor corneas, very few patients receive a corneal graft. Educational programmes are vital to increase awareness of corneal blindness and the value of corneal donations.

Keywords

• Penetrating keratoplasty
• corneal transplantation
• corneal grafts