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Gender differences in keratoconus keratoplasty: a 25-year study in Southern Brazil and global perspective

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Abstract

Purpose

To compare the characteristics and outcomes of male and female patients that underwent corneal transplantation for keratoconus (KC) in Southern Brazil and worldwide.

Methods

Retrospective longitudinal study that evaluated medical records of patients who were submitted to keratoplasty between August 1990 and September 2015 in two tertiary hospitals in the state of Rio Grande do Sul (Brazil) and review of the Medline and Embase database international literature.

Results

Out of a total of 4026 corneal transplants at that period, 1284 patients (1530 eyes) received preoperative diagnosis of KC (31.8%). A total of 839 men underwent keratoplasty for KC (65.4%) with mean age of 30.3 (±12.2) years. The 445 transplanted women (34.6%) had a mean age of 34.5 (±14.8) years. Both differences were statistically significant (p < 0.01). Regarding laterality, skin color, recipient and donor cornea trephination diameter, and rejection episodes there was no significant difference between the two groups at baseline (p > 0.05). Females were submitted significantly more to deep anterior lamellar keratoplasty (DALK) in comparison with males (26.5 vs. 15.7%, p < 0.01). We were able to include 57.4% of the original keratoplasties for our follow-up data analysis. Male sex and penetrating keratoplasty (PK) were associated significantly with increased risk for graft failure in KC transplantation at the end of follow-up (p < 0.05). The mean follow-up of transplanted patients was similar in both groups.

Conclusion

Keratoconus is the most transplanted corneal disease in Southern Brazil and globally. Studies in Africa, Asia, Europe and North America also showed gender differences in KC patients submitted to keratoplasty. We found that men were transplanted in a 1.9 male/female ratio and at an earlier age than women. At final follow-up, male sex and PK were risk factors associated with increased graft failure. It is essential to broaden the hormonal and genetic investigations to elucidate why keratoconic males have undergone more keratoplasties and have more secondary failure than females.

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Acknowledgements

Thank you to Mirna Bernardes and Dayane Munhoz for their assistance with this study data collection.

Funding

This study received funding from the Brazilian National Research and Development Council (CNPq).

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Authors and Affiliations

  1. Genetic and Molecular Biology Postgraduate Program, Federal University of Rio Grande do Sul, 333 Mostardeiro st, office 503, Porto Alegre, RS, 90430-001, Brazil

    Otavio A. Magalhaes

  2. Cornea Division, Jules Stein, UCLA, Los Angeles, CA, USA

    Otavio A. Magalhaes

  3. Department of Ophthalmology, Federal University Hospital of Rio Grande do Sul, 2350 Ramiro Barcellos Street, Porto Alegre, RS, Brazil

    Samara B. Marafon

  4. Department of Ophthalmology, Porto Alegre Eye Bank Hospital, 831 Engineer Walther Bohl Street, Porto Alegre, RS, Brazil

    Raissa C. Ferreira

Authors
  1. Otavio A. Magalhaes
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  2. Samara B. Marafon
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  3. Raissa C. Ferreira
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Corresponding author

Correspondence to Otavio A. Magalhaes.

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Conflict of interest

Author OAM has received grants from the Brazilian National Research and Development Council. He has no commercial interest on this research. Author RCF and SBM did not receive any grant and have not conflict of interest. None of the authors receive any company honorarium.

Ethical approval

This study was approved by the Federal University Hospital ethical committee/review board (under protocol number 15-0559) and adhered to the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Review Board granted a waiver of consent for chart review.

Human and animals rights

This article does not contain any studies with animals performed by any of the authors.

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Magalhaes, O.A., Marafon, S.B. & Ferreira, R.C. Gender differences in keratoconus keratoplasty: a 25-year study in Southern Brazil and global perspective. Int Ophthalmol 38, 1627–1633 (2018). https://doi.org/10.1007/s10792-017-0634-z

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  • DOI: https://doi.org/10.1007/s10792-017-0634-z

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