Indications and Outcomes of Corneal Transplant Surgery in Ghana

Seth Lartey1, Ellen Konadu Antwi-Adjei2, Abdul Kabir Mohammed2, Emmanuel Owusu Poku2

1. Department of Eye, Ear, Nose and Throat, School of Medical Sciences, College of Health Science, Kwame Nkrumah University of                  Science and Technology, Kumasi, Ghana
2. Department of Optometry and Visual Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi,              Ghana                      

Correspondence to: Dr. Seth Lartey; Email: sylartey.chs@knust.edu.gh

Received: 1st May, 2020; Revised: 15th December, 2020; Accepted: 9th January, 2021; Available online: 22nd April 2021

Abstract

Background: Corneal blindness contributes to 25% of all blindness. We review corneal transplant, a common surgical remedy, in Ghana to determine indications and visual outcomes in resource-poor environments. Methods: A retrospective cross-sectional study of keratoplasty evaluating indications, pre- and postoperative outcomes complications and their associations, between January 2014 and December 2018 at a teaching hospital in Ghana. Descriptive statistics and McNemar’s test were used for the analyses. Results: Seventy-five eyes were studied. The mean ± standard deviation (SD) age of patients was 45.08 ± 17.85 years, the majority being 20–39 years (58.7% were male). Pseudophakia bullous keratopathy (PBK) was the commonest indication for keratoplasty (26.7%) followed by keratoconus (21.3%). Preoperatively 96% of eyes were blind with vision <3/60 with 64% out of the total eyes with vision <1/60. Postoperatively, 60% of all grafts had uncorrected vision of 3/60 or better after the last follow-up. McNemar’s test revealed a statistically significant difference between postsurgical and pre-surgical visual acuity (VA) (p < 0. 001). The median follow-up period was 12 months. The commonest postsurgical complication was raised intraocular pressure (IOP) (22.7%) with a total of 14.7% of grafts failures. Conclusion: In this setting, PBK is the leading indication for corneal transplant. Visual outcomes for corneal transplant in this resource-poor area are not worse than in other settings. We need to pay attention to corneal transplant services to cater for the expected increase in PBK from the increasing cataract surgical rate.

Keywords: Indications, Outcomes, Corneal Transplant, Keratoplasty 


Ann Afr Surg. 2021 ; 18(3): 137-142 
DOI : http://dx.doi.org/10.4314/aas.v18i3.3
Conflicts of Interest: None
Funding: None
© 2021 Author. This work is licensed under the Creative Commons Attribution 4.0 International License 

Introduction

Blindness and visual impairment resulting from diseases of the cornea are a significant public health problem in the developing world (1). In Africa, corneal disease contributes to about 25% of all blindness compared to 2% in the United Kingdom and other developed countries, 4.5% in India, and 7% worldwide (2–4). Many of these corneal diseases will require corneal transplantation.
Corneal transplantation is the surgical replacement of a diseased host corneal tissue with a healthy donor cornea (4). Worldwide, there are an estimated 12.7 million patients in need of corneal transplant, whereas only one cornea is available for every 70 persons (5). The imbalance in the supply and demand is further aggravated in developing countries where corneal transplantation procedures are rarely performed, due to multiple factors (5, 6). General indications for corneal transplant have been categorized under four main umbrellas which include optical, tectonic, therapeutic, and cosmetic (4).
The corneal transplant service in Ghana is inadequate as there is no corneal banking service in addition to there being only a few trained surgeons in the country (7). It is imperative to note that the few corneal tissues used were imported into the country, and also there were only two surgeons trained to perform corneal transplant in Ghana at the time of this study.
This study reviews corneal transplantation in Ghana and analyzes the indications and outcomes of the surgery. There has been no known study on the indications and outcomes of this procedure since its commencement in the country. This will serve as a guide to assist in restructuring local policies on corneal transplantation services.

                                                       

Methods

This was a retrospective cross-sectional study conducted at the Komfo Anokye Teaching Hospital (KATH) located in Kumasi, Ghana. The study population consisted of patients that had undergone keratoplasty from January, 2014 to December, 2018.
The inclusion criteria were all corneal transplant surgeries performed and recorded within the study period and who had completed a minimum of 3 months follow-up. The maximum follow-up end point was a year (12 months) after surgery. The exclusion criteria were incomplete record data, keratoprosthetics, and corneal transplant performed for non-optical reasons. Primary identification of keratoplasty procedures from the theater registers was done, and the services of records personnel were obtained for case file extraction. Variables extracted from the participant’s records were: demographics, indication for surgery, type of surgery, preoperative and postoperative visual acuity (VA), and postoperative complications including graft rejection. 
All transplant surgery was done by trained corneal specialist and tissues were obtained from CornealGen (http://corneagen.com/) and imported by courier preserved in OptiSol (Chiron Ophthalmics, Irvine, California) and ice packs. Graft failure was defined as either primary graft failure or secondary graft failure resulting in a significant permanent central macular corneal haze or opacity in the donor button.
Ethical approval was obtained from the Committee on Human Research, Publications and Ethics of KNUST, School of Medical Sciences and Komfo Anokye Teaching Hospital (Ref. No: CHRPE/AP/086/19).
Structured data extraction sheet and Excel worksheets were used manually to transcribe data from patients’ records. Data was analyzed using IBM SPSS Statistics 20.0. Descriptive statistics tools were used to describe the demographics. McNemar’s test was used to assess change in vision before and after corneal transplant.