Indikasi dan Jenis Transplantasi Kornea : Penelitian Retrospektif di RS Mata JEC periode 2014-2018

Abstract

Purpose : Corneal disorders leading to corneal blindness was one of the major causes for blindness worldwide. This retrospective study was done to report the indications for corneal transplantation and also the latest surgical technique between lamellar and penetrating keratoplasty at JEC Hospital, Jakarta Indonesia from 2014 to 2018. Methods : Records of all patients who underwent penetrating and lamellar keratoplasties at our hospital between 2014 and 2018 were reviewed retrospectively. Patient demographic data such as age and gender, together with indications and surgical technique of corneal transplantation were recorded and analysed. Results : Pseudophakic bullous keratopathy, corneal scarring post infection, and corneal dystrophy were the most common indications for corneal transplantation in our centre (33.91%; 28%; 16.63%; respectively). In 2014, corneal ulcer was one of the leading causes for complete corneal transplantation (12.5%) but its incidence was decreasing each year. 66.55% of procedures performed were penetrating keratoplasty. However, the shift from penetrating to lamellar procedures such as DSAEK increases significantly since 2007 and even more increased by 2 times within the last 5 years (15.27%; 35%; respectively). Conclusion : The number of keratoplasties in JEC has increased from 2014 to 2018. Since 2007, posterior lamellar keratoplasties have increased and began to create some shift from penetrating to lamellar since then. There was a constant increase number of DSAEK due to donor availability from the new eye bank in 2017. The shorter recovery time after DSAEK seems to contribute to the trend toward earlier operative intervention in corneal endothelial disease. The leading indications for DSAEK was bullous keratopathy.Tujuan : Kelainan kornea merupakan salah satu penyebab kebutaan di dunia. Penelitian retrospektif ini bertujuan untuk melaporkan insidens serta indikasi transplantasi kornea baik keseluruhan (penetrating) atau sebagian (lamellar) di RS Mata JEC periode 2014 hingga 2018. Metode : Seluruh rekam medis pasien yang telah melakukan transplantasi kornea baik secara menyeluruh atau hanya sebagian di RS Mata JEC periode 2014 hingga 2018 dikumpulkan. Data diolah secara retrospektif. Data demografis seperti usia, jenis kelamin, indikasi dan jenis transplantasi kornea dikelompokkan dan dianalisa. Hasil : Indikasi terbanyak dilakukannya transplantasi kornea di RS Mata JEC adalah Pseudophakic Bullous Keratopathy, jaringan skar pasca infeksi dan kelainan kornea bawaan (33.91%; 28%; 16.63%). Pada tahun 2014, penyebab terbanyak dilakukannya transplantasi kornea secara keseluruhan adalah ulkus kornea. Seiring berjalannya waktu dan perkembangan teknologi, jumlah angka transplantasi kornea secara menyeluruh mengalami penurunan dan mulai tergantikan oleh transplantasi kornea sebagian sejak tahun 2007. Insidens pergantian ini dilaporkan hingga meningkat 2 kali lipat dalam 5 tahun terakir (15.27%; 35%) Kesimpulan : Jumlah transplantasi kornea di RS Mata JEC meningkat tahun 2014 – 2018. Sejak tahun 2007, transplantasi kornea sebagian/endothelial keratoplasty semakin meningkat. Latar belakang angka endothelial keratoplasty yang terus meningkat salah satunya adalah jumlah ketersediaan donor kornea yang terus bertambah dan angka pemulihan yang lebih singkat pasca operasi karena hanya sebagian bukan keseluruhan kornea yang diganti. Penyebab utama kebutaan kornea di Indonesia saat ini adalah bullous keratopathy.