FALÊNCIA E SOBREVIDA DOS ENXERTOS CORNEANOS SEGUNDO TÉCNICA CIRÚRGICA: UMA ANÁLISE EPIDEMIOLÓGICA

Abstract

The object of this study is the failure and survival of corneal grafts performed using lamellar and penetrating techniques during keratoplasty. Corneal diseases represent the main causes of blindness worldwide, and corneal transplantation is the main method of treatment performed in these cases. Among the keratoplasty techniques, the penetrating technique is the most frequently used compared to the lamellar one. The penetrating technique aims to replace all layers of corneal tissue, while the lamellar technique replaces only the diseased layer and seeks to minimize the risk of graft rejection. This study is justified because it covers an important gap in knowledge, based on information related to surgical procedures, patients involved, pre- and post-operative follow-ups, and other variables related to the object studied. The objective was to analyze the failure and survival of corneal grafts performed using the lamellar technique compared to the penetrating technique. This is an epidemiological, observational, descriptive, and analytical study, by a retrospective cohort of two groups, with analysis of patients undergoing corneal transplantation to estimate graft survival and outcomes by group, defined by the technical modality of the surgery performed, with identification of the chances of occurrence of failure and graft survival. The data were organized in the first half of 2022 from secondary sources of patients seen by the Human Eye Tissue Bank of a large hospital in the capital state of Mato Grosso do Sul, referring to the five-year time frame (2014 to 2018). This cut-off is justified because it is a period with regular performance of procedures, for being prior to the pandemic period generated by COVID-19 and having the data organized systematically. The data were analyzed descriptively and inferential, using the free statistical software R, version 4.0.2, with analysis of graft survival by surgical modality, and collected after ethical approval, under protocol approval No. 3,177,423. We investigated 817 corneal transplant procedures performed between the years 2014 and 2018 in the studied service. Of these, 705 (86.29%) were performed using the penetrating keratoplasty technique and 112 (13.71%) using the lamellar technique. Cumulative survival probabilities of 42% and 5% were found for those transplanted by the lamellar technique for the intervals of one month and one year respectively. For the penetrating technique, the rates were 84% and 42% for the same intervals. It was identified that the penetrating transplant was the most used in the period and that it presents a higher failure rate compared to the lamellar technique. As for the survival of the corneal graft, the transplants performed by the penetrating technique presented a higher survival rate compared to the lamellar technique.