Effect of Corneal Transplantation on Patient-Reported Outcomes and Potential Predictors: A Systematic Review

• Published in: Cornea Vol. 39; no. 11; pp. 1463 - 1472
• Main Authors: Vreijsen, Eline, Elsman, Ellen B. M., van Nispen, Ruth M. A., Nuijts, Rudy M. M. A., van Rens, Ger H. M. B.
• Format: Journal Article
• Language: English
• Published: United States Cornea 01-11-2020; Copyright Wolters Kluwer Health, Inc. All rights reserved
• ISSN: 0277-3740; 1536-4798
• DOI: 10.1097/ICO.0000000000002412

PURPOSE:To investigate the effect and potential predictors of corneal transplantation on patient-reported outcomes such as quality of life, visual functioning, and mental health by systematically reviewing the literature.
METHODS:Studies with 1 preoperative and at least 1 postoperative measurement were searched for in relevant literature databases. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies, and effect sizes were calculated.
RESULTS:Of 1445 unique publications, 14 studies, including 15 study designs, were described in 16 publications. Four randomized controlled trials, 1 controlled clinical trial, 1 cohort study, and 1 before–after study (BA) were of good quality; 6 BAs were of moderate quality; and 2 BAs were of weak quality. Patients generally improved 12 months after transplantation on health-related quality of life (effect size between 0.08 and −3.06), vision-related quality of life (−0.67 and −6.65), visual functioning (−0.55 and −0.63), and subjective visual symptoms (−0.31 and −0.86). Patient satisfaction was high (−0.95). Patients improved on depression (−0.31) but remained stable on anxiety (−0.05) 4 months after transplantation. Predictors of positive outcomes were lower preoperative visual acuity and visual functioning, better postoperative visual factors, younger age, and male sex.
CONCLUSIONS:Corneal transplantation showed overall beneficial effects on patient-reported outcomes. Knowledge of these effects and predictors might result in better treatment, more patient-centered care, and more realistic expectations on the part of patients and ophthalmologists. Future studies should focus on not only health- and vision-related quality of life but also mental health and labor participation using longitudinal study designs.