Corneal surgery in the flying eye hospital: characteristics and visual outcome

Objective: The Flying Eye Hospital (FEH) of ORBIS International is a capacity-building platform that trains ophthalmologists throughout the developing world on-board a fully functional eye hospital based in an airplane and in the local hospitals of developing countries. Corneal blindness (CB) is the second leading cause of blindness in most developing countries. Treatment of existing global CB requires effective eye banking and surgeons trained in corneal transplant. ORBIS International has programs that addressed both those needs. This study reports the clinical outcome of all keratoplasty training programs of the FEH from January 2010 to December 2014. Methods: Surveys were sent to all local ophthalmologists trained on FEH to perform keratoplasty in the relevant time period. The survey included patient demographics, procedure performed, indications for surgery, postoperative steroid regiment, and visual acuity (VA). Results: Keratoplasty was undertaken in 87 eyes as follows: penetrating keratoplasty (PK) in 66 (75.9% of our population), deep anterior lamellar keratoplasty (DALK) in 6 (6.9%), Descemet's stripping endothelial keratoplasty (DSEK) in 14 (16.1%), and Boston keratoprosthesis (KP) in 1 (1.1%). Corneal clouding was the indication in 83 (95.4%) of patients. Forty-seven (54%) patients returned for long-term care with the mean follow-up (FU) of 32.0 months (range 6-60 months). Thirteen (27.7%) were not using any steroids at last the FU. Eleven (23.4%) patients had signs of graft rejection. Best-corrected VA in meters and feet, respectively, was 6/6 to 6/18 (20/20 to 20/60) in 12 (25.5%) patients, 6/18 to 6/60 (20/60 to 20/200) in 19 (40.4%) patients, 6/60 to 3/60 (20/200 to 20/400) in 4 (8.5%) patients, and less than 3/60 (20/400) in 12 (25.5%) patients. Conclusion: Clinical outcomes delivered by FEH keratoplasty training are acceptable compared to results in the developing world and to some reports of training programs in the developed world, though our study is limited by its retrospective nature and the poor rate of FU.