Long-term survival of corneal transplants and visual outcomes among private patients of corneal surgeons in Metropolitan Manila (the Philippines)

  • David Francis Fullon Chan Philippine General Hospital
  • Ma. Dominga B. Padilla Department of Ophthalmology and Visual Sciences. Philippine General Hospital, University of the Philippines Manila , Manila
Keywords: keratoplasty, transplant, survival, Philippines


PURPOSE: There are currently no published studies on the outcomes of keratoplasty in the Philippines.  This study aimed to report graft survival rates at years 1, 3, and 5 after surgery, visual outcomes, and causes of graft failure among private patients of corneal surgeons in Metropolitan Manila receiving tissue from a single local eye bank in the period 2008-2012. 

DESIGN: Retrospective cohort, multicenter study.

METHODS: POPULATION: Private patients of Metro Manila corneal surgeons, receiving tissue from the Santa Lucia International Eye Bank of Manila in 2008-2012.  241 of 593 yielded sufficiently complete data sets. PROCEDURE: Donor and tissue characteristics, pre-op and latest follow-up characteristics/clinical findings were retrieved and processed. Data from the eye bank was merged with follow-up data from surgeons submitted March-October 2014. MAIN OUTCOME MEASURES: Survival rates at 1, 3, and 5 years; best-corrected visual acuity as of latest follow-up; causes of failure.

RESULTS:  1-year survival: 90.4%, 3-year: 71.5%, 5-year: ~52.7%. Overall, 43.5% had VA of 20/50 or better, and 25% counting fingers or worse, with variations across diagnoses.

CONCLUSION: Though small in sample size and response rate, survival trends parallel studies with larger populations elsewhere. Specific trends like favorable survival in keratoconus were consistent. Indications for surgery have changed little since 2005, but regraft has become the most common indication. Further data collection and completion are required for multivariate analysis on factors regarding survival.  Inflammation, infection, trauma, poor adherence are among the identified reasons for failure.



1.Oliva MS, Schottman T, Gulati M. Turning the tide of corneal blindness. Indian J Ophthalmol 2012;60:423-427.
2. World Health Assembly Document A62/7: Action plan for the prevention of avoidable blindness and visual impairment 2009-2013, pp. 7-17. Geneva: WHO Press 2009.
3. Pascolini D, Mariotti SP. Global estimates of visual impairment 2010. Br J Ophthalmol 2012;96:614-618.
4. Resnikoff S, Pascolini D, Etya’ale D, et al. Global data on visual impairment in the year 2002. Bull World Health Organ 2002;82:844-851.
5. Dandona R, Dandona L. Corneal blindness in a southern Indian population: Need for health promotion strategies. Br J Ophthalmol 2003;87:133-141.
6. Dandona L, Dandona R, Naduvilath TJ, et al. Is current eye-care-policy focus almost exclusively on cataract adequate to deal with blindness in India? Lancet 1998;351:1312-1316.
7. Lewallan S, Courtright P. Blindness in Africa: Present situation and future needs. Br J Ophthalmol 2001;85:897-903.
8. Cubillan LDP, Olivar-Santos. Third national survey on blindness. Philipp J Ophthalmol 2005;30(3):100-114.
9. Padilla MDB, Eltanal-Pascual MAT. Indications for penetrating keratoplasty in the Philippines. Philipp J Ophthalmol 2005;30(1):148-152.
10. Moffatt SL, Cartwegith VA, Stumpf TH. Centennial review of corneal transplantation. Clin Exper Ophthalmol 2005;33(6):642-657.
11. Claesson M, Armitage WJ. Ten-year follow-up of graft survival and visual outcome after penetrating keratoplasty in Sweden. Cornea 2009;28(10):1124-1129.
12. Tan DTH, Janardhanan P, Zhou H, et al. Penetrating Keratoplasty in Asian Eyes: The Singapore Corneal Transplant Study. Ophthalmology 2008;115(6):975-982.e1.
13. Williams KA, Lowe MT, Bartlett CM, et al. The Australian Corneal Graft Registry 2007 Report. Bedford Park: Flinders University Press 2007.
14. Fagerholm P, et al. A biosynthetic alternative to human donor tissue for inducing corneal regeneration: 24-month follow-up of a phase 1 clinical study. Sci Transl Med 2010;25;2(46):46ra61.
15. Gomaa A, Comyn O, Liu C. Keratoprostheses in clinical practice – a review. Clin Exper Ophthalmol 2010;38:211-224.
16. Whitcher JP, Srinivasan M, Upadhyay, MP. Corneal blindness: a global perspective. Bull WHO 2001;79:214-221.
17. Módis L Jr, Szalai E, Facskó A, et al. Corneal transplantation in Hungary (1946-2009). Clin Exper Ophthalmol 2011;39(6):520-525.
18. Fasolo A, Capuzzo C, the CORTES Study Group. Risk Factors for Graft Failure After Penetrating Keratoplasty: 5-Year Follow-Up From the Corneal Transplant Epidemiological Study. Cornea 2011;30:1328-1335.
19. Cornea Donor Study Investigator Group. The effect of donor age on corneal transplantation outcome: results of the cornea donor study. Ophthalmology 2008;115:620-626.
20. Li JY, Mannis MJ. Eye banking and the changing trends in contemporary corneal surgery. Int Ophthalmol Clin 2010;50(3):101-112.
21. Niziol LM, Musch DC, Gillesipe BW, et al. Long-Term Outcomes in Patients Who Received a Corneal Graft for Keratoconus Between 1980 and 1986. Am J Ophthalmol 2013;155(2):213-219.
22. Basu S, Reddy JC, Vaddavalli PK, et al. Long-term Outcomes of Penetrating Keratoplasty for Keratoconus With Resolved Corneal Hydrops. Cornea 2012;31(6):615-620.
Original Article