Health-related quality of life (HRQOL) refers to issues associated with a person’s perception of physical and mental well-being, which can be affected by illness and medical treatment [
Measuring quality of life in ophthalmology has been confirmed as an important tool for evaluating eye diseases and the impact of interventions [
Some corneal diseases, usually in the late stage, require corneal transplantation [
Actually, patients can easily appraise the graft and estimate the overall results on daily living and in respect of their expectations. Furthermore, while corneal transplantation is performed to treat a corneal disease, surgeons have a reasonable expectation that surgery will lead to a significant improvement in their patient’s overall physical and mental health [
However, the global impact of the corneal transplantation on the patient’s health status or satisfaction is largely unknown.
Studies that have considered the issue of health status in corneal transplantation have used vision-targeted health-related quality of life instruments (VF-14, VFQ) [
Despite the disparities in the number of patients, such studies have shown that postgraft visual function significantly affects health status and that visual acuity in the nonoperated eye is the strongest factor associated with improvement of visual function.
Only two published surveys [
In the framework of the Corneal Transplant Epidemiological Study (CORTES) [
The corneas distributed by the Veneto Eye Bank Foundation (about 2,000 per year in the 2002–2008 period) represent approximately 40% of corneal tissues transplanted in Italy [
All the consecutive patients scheduled for elective penetrating or anterior lamellar keratoplasty during the CORTES recruitment period (October 2001–October 2004) were considered eligible for HRQOL and satisfaction evaluation.
Exclusion criteria were age below 18 years, presence of invalidating diseases that could cause difficulties during the interview, and patient or surgeon refusal of the interview.
HRQOL data were collected through standardized telephone interviews, carried out by personnel of the CORTES Follow-Up Unit during the week prior to corneal transplantation and one year following surgery. Assessment of patient satisfaction was completed at the time of the second interview.
Patients’ clinical history, type of intervention, postoperative clinical assessment, adverse reactions and complications, and visual acuity and graft condition after one year were obtained from the CORTES database.
The study protocol was approved by the Ethical Committee of the University of Padua. Full details about the study and the list of contributing surgeons have been reported elsewhere [
The SF-12 Health Survey [
The questionnaire, validated in Italian [
Validation studies showed that PCS-12 and MCS-12 range from 11 to 70 and from 7 to 72, respectively. Both summary scores are standardized to have a mean of 50 and a standard deviation of 10, with higher scores indicating better health status perception [
SF-12 summary scores were examined in relation to sociodemographic and graft-related variables. On the basis of previous results [
To evaluate satisfaction we used 6 items on expectation and satisfaction comprised in the 24-item questionnaire designed by Williams et al. at Flinders University of South Australia, Adelaide [
Patients who completed the two SF-12 interviews and the satisfaction questionnaire were considered for evaluation.
Analyses on the SF-12 were conducted with SAS version 9.1.3 statistical software (SAS Institute Inc., Cary, NC, USA) following the methods reported in the user manual [
Mean values and 95% confidence intervals for PCS-12 and MCS-12 were calculated according to patients’ social and disease-related characteristics reported to influence the HRQOL.
Results of descriptive analyses are expressed as mean and standard deviation (SD) for quantitative variables and as counts and percentages for categorical variables, unless otherwise specified. Chi square test was used to compare categorical variables in eligible and interviewed patients and Wilcoxon-Mann-Whitney nonparametric test to compare median of ages. Chi square test was also used to evaluate differences among patients in relation to their satisfaction after transplantation. All
In order to assess the magnitude and meaning of health status changes we use the effect size (ES) calculated by taking the differences between means before treatment and after treatment and dividing it by the SD of the same measure before treatment. As suggested by Kazis et al. [
A total of 2,329 patients (44.7%) were considered to be eligible over the total of 5,210 that underwent corneal transplantation during the study period.
Among the eligible patients, 785 (33.7%) missed the baseline interview (529 did not answer the phone call, 92 declined the consent, 89 underwent surgery at an earlier date, 56 had linguistic problems, and 19 did not answer for other reasons). A further 321 patients (13.8%) missed the one-year-after-surgery interview and were therefore excluded from the analysis (185 did not answer the phone call, 92 refused the interview; 31 had been already regrafted because of graft failure, and 13 had difficulty in carrying on the interview).
Ultimately, 1,223 patients (52.5%) referring to 96 ophthalmic surgeons in 66 centers answered the two SF-12 and the satisfaction questionnaire.
Sociodemographic and clinical characteristics of the entire cohort, eligible and interviewed patients are reported in Table
Sociodemographic and clinical characteristics of patients.
Cohort No. (%) | Eligible No. (%) | Interviewed No. (%)* | ||
5,210 (100) | 2,329 (44.7) | 1,223 (52.5) | ||
Gender | 0.858 | |||
Male | 3,040 (58.3) | 1,362 (58.5) | 719 (58.8) | |
Female | 2,170 (41.7) | 967 (41.5) | 504 (41.2) | |
Age (y) | ||||
Mean (SD) | 49.0 (19.8) | 46.8 (17.9) | 45.8 (16.9) | |
Male | 46.0 (19.2) | 44.1 (17.6) | 43.9 (16.8) | |
Female | 53.1 (19.9) | 50.4 (17.8) | 48.6 (16.6) | |
Median | 46.0 | 44.0 | 43.0 | 0.266 |
Male | 42.0 | 40.0 | 41.0 | 0.972 |
Female | 53.0 | 49.0 | 47.0 | 0.084 |
Marital status | ||||
Married | n.c. | n.c. | 676 (57.1) | |
Single | 412 (34.8) | |||
Widow | 62 (5.2) | |||
Divorced | 34 (2.9) | |||
| ||||
Education | ||||
High school | n.c. | n.c. | 457 (39.4) | |
Secondary school | 311 (26.8) | |||
Primary school | 227 (19.6) | |||
Degree | 143 (12.3) | |||
None | 22 (1.9) | |||
| ||||
Working status | ||||
Partial or full time | n.c. | n.c. | 632 (55.6) | |
Retired | 222 (19.5) | |||
House keeper | 181 (15.9) | |||
Student | 65 (5.7) | |||
Jobless | 36 (3.2) | |||
| ||||
Reason for graft | 0.026 | |||
Optical | 4,183 (90.8) | 1,994 (92.5) | 1,085 (94.7) | |
Tectonic | 228 (4.9) | 84 (3.9) | 26 (2.3) | |
Pain reduction | 197 (4.3) | 78 (3.6) | 34 (3.0) | |
| ||||
Type of keratoplasty | 0.227 | |||
Penetrating | 4,696 (90.1) | 2,157 (92.6) | 1,146 (93.7) | |
Anterior lamellar | 514 (9.9) | 172 (7.4) | 77 (6.3) | |
Clinical indication | 0.386 | |||
Ectasia/thinning | 2,550 (48.9) | 1,298 (55.7) | 730 (59.7) | |
Regraft ( | 674 (12.9) | 304 (13.0) | 148 (12.1) | |
Pseudophakic corneal edema | 594 (11.4) | 195 (8.4) | 87 (7.1) | |
Primary endotheliopathies | 335 (6.4) | 140 (6.0) | 82 (6.7) | |
Mechanical trauma | 174 (3.3) | 76 (3.3) | 36 (3.0) | |
Viral/postviral keratitis | 129 (2.5) | 50 (2.2) | 25 (2.0) | |
Stromal corneal dystrophy | 79 (1.5) | 35 (1.5) | 23 (1.9) | |
Aphakic corneal edema | 102 (2.0) | 30 (1.3) | 14 (1.2) | |
Optical/refractive | 67 (1.3) | 36 (1.6) | 14 (1.2) | |
Microbial/postmicrobial keratitis | 76 (1.5) | 32 (1.4) | 13 (1.1) | |
Noninfectious ulcerative keratitis | 177 (3.4) | 38 (1.6) | 10 (0.7) | |
Chemical injures | 36 (0.7) | 8 (0.3) | 3 (0.2) | |
Other ( | 217 (4.2) | 87 (3.7) | 38 (3.1) | |
Previous keratoplasty | 0.369 | |||
No | 4,094 (86.1) | 1,896 (86.2) | 1,020 (87.3) | |
Yes | 663 (13.9) | 303 (13.8) | 148 (12.7) | |
| ||||
Previous surgery ( | 0.120 | |||
No | 3,251 (68.3) | 1,610 (73.2) | 884 (75.7) | |
Yes | 284 (31.7) | 589 (26.8) | 284 (24.3) | |
| ||||
Other ocular diseases | 0.345 | |||
No | 3,700 (77.2) | 1,734 (77.0) | 939 (78.5) | |
Yes | 1096 (22.8) | 515 (23.0) | 257 (21.5) | |
Systemic diseases | 0.455 | |||
No | 3,657 (78.6) | 1,723 (77.8) | 933 (78.9) | |
Yes | 997 (21.4) | 491 (22.2) | 249 (21.1) | |
*Proportion of the eligible patients; n.c.: data not collected;
A significant difference between interviewed and eligible patients (
Best corrected visual acuity (BCVA) before transplantation is reported in Table
A total of 54 (4.4%) grafts failed and one or more adverse reactions/complications (AE/C), for example, IOP elevation, suture-related problems, and rejection episodes, occurred in 188 (15.4%) patients within the first year of follow-up.
The answers to the first item of SF-12 at baseline (
Health in general at baseline (
Excellent/very good | Good | Fair/poor | Total | ||
Excellent/very good | 142 (19.7) | 81 (11.3) | 7 (1.0) | 230 (32.0) | |
Good | 111 (15.4) | 293 (40.8) | 31 (4.3) | 435 (60.5) | |
Fair/poor | 6 (0.8) | 29 (4.0) | 19 (2.7) | 54 (7.5) | |
Total | 259 (35.9) | 403 (56.1) | 57 (8.0) | 719 (100.0) |
Health in general at baseline (
Excellent/very good | Good | Fair/poor | Total | ||
Excellent/very good | 46 (9.1) | 54 (10.7) | 1 (0.2) | 101 (20.0) | |
Good | 39 (7.8) | 211 (41.9) | 48 (9.5) | 298 (59.2) | |
Fair/poor | 6 (1.2) | 47 (9.3) | 52 (10.3) | 105 (20.8) | |
Total | 91 (18.1) | 312 (61.9) | 101 (20.0) | 504 (100.0) |
PCS-12 and MCS-12 (
PCS-12 | MCS-12 | ||||||
---|---|---|---|---|---|---|---|
ES* | |||||||
Total | 1,223 | 50.8 (50.4–51.2) | 50.2 (49.8–50.6) | 0.09 | 48.4 (47.8–49.0) | 50.4 (49.8–51.0) | 0.19 |
Gender | |||||||
Male | 719 | 51.5 (51.0–51.9) | 51.4 (50.9–51.9) | −0.01 | 50.8 (50.1–51.4) | 52.4 (51.7–53.1) | 0.18 |
Female | 504 | 49.9 (49.3–50.6) | 48.5 (47.8–49.2) | −0.18 | 45.0 (44.0–46.0) | 47.6 (46.6–48.6) | 0.23 |
Male, age groups (y) | |||||||
18–24 | 88 | 52.8 (51.5–54.2) | 52.5 (51.3–53.7) | −0.06 | 49.8 (47.8–51.9) | 51.0 (48.9–53.0) | 0.12 |
25–34 | 178 | 51.9 (51.0–52.8) | 52.7 (51.9–53.5) | 0.13 | 50.5 (49.3–51.7) | 53.1 (52.0–54.2) | 0.33 |
35–44 | 155 | 51.5 (50.6–52.5) | 51.5 (50.5–52.6) | — | 49.8 (48.2–51.3) | 51.2 (49.7–52.6) | 0.15 |
45–54 | 111 | 52.1 (50.8–53.3) | 51.3 (50.0–52.6) | −0.11 | 49.3 (47.3–51.2) | 51.3 (49.4–53.1) | 0.19 |
55–64 | 85 | 50.3 (49.1–51.6) | 51.0 (49.7–52.1) | 0.10 | 52.2 (50.1–54.2) | 54.9 (53.3–56.6) | 0.29 |
65–74 | 59 | 50.8 (49.6–52.1) | 48.4 (46.7–50.0) | −0.49 | 55.0 (53.2–56.8) | 54.6 (52.2–57.0) | −0.06 |
≥75 | 43 | 48.4 (46.1–50.7) | 49.4 (47.0–51.8) | 0.13 | 52.5 (49.4–55.7) | 51.9 (48.1–55.6) | −0.06 |
Female, age groups (y) | |||||||
18–24 | 27 | 52.6 (50.1–55.1) | 52.2 (49.9–54.5) | −0.07 | 43.6 (39.1–48.2) | 50.4 (46.1–54.6) | 0.60 |
25–34 | 108 | 50.3 (48.8–51.8) | 50.8(49.6–52.0) | 0.06 | 42.1 (40.0–44.2) | 45.7 (43.6–47.8) | 0.33 |
35–44 | 91 | 51.2 (49.6–52.7) | 49.9 (48.3–51.5) | −0.17 | 44.9 (42.6–47.1) | 48.6 (46.4–50.9) | 0.35 |
45–54 | 101 | 50.5 (48.9–52.0) | 49.4 (48.0–50.8) | −0.14 | 45.1 (42.9–47.3) | 48.0 (45.8–50.2) | 0.26 |
55–64 | 72 | 49.8 (48.3–51.3) | 47.4 (45.3–49.4) | −0.38 | 47.6 (44.8–50.3) | 48.2 (45.6–50.8) | 0.05 |
65–74 | 70 | 48.4 (46.6–50.1) | 45.7 (43.6–47.9) | −0.36 | 48.0 (45.7–50.3) | 49.4 (46.2–52.5) | 0.14 |
≥75 | 35 | 45.7 (43.1–48.3) | 41.6 (38.2–44.9) | −0.52 | 43.8 (39.9–47.7) | 43.3 (39.5–47.0) | −0.05 |
Marital status | |||||||
Married | 676 | 51.1 (50.6–51.5) | 50.0 (49.4–50.5) | −0.16 | 48.8 (48.1–49.6) | 50.6 (49.8–51.4) | 0.17 |
Single | 412 | 51.3 (50.6–51.9) | 51.5 (50.9–52.1) | 0.04 | 48.3 (47.3–49.3) | 50.8 (49.9–51.7) | 0.24 |
Widow/divorced | 96 | 47.2 (45.6–48.8) | 45.9 (43.9–47.8) | −0.17 | 45.6 (43.0–48.1) | 47.7 (45.2–50.4) | 0.17 |
Education | |||||||
High school | 457 | 51.2 (50.6–51.8) | 51.2 (50.6–51.8) | — | 48.1 (47.1– 49.0) | 50.1 (49.2–51.0) | 0.20 |
Secondary school | 311 | 51.1 (50.3–51.9) | 50.1 (49.4–50.9) | −0.13 | 48.2 (47.1–49.4) | 51.2 (50.0–52.3) | 0.28 |
Primary school | 227 | 49.0 (48.2–49.9) | 47.5 (46.4–48.5) | −0.23 | 49.0 (47.6–50.4) | 50.7 (49.2–52.1) | 0.16 |
Degree | 143 | 52.7 (51.8–53.6) | 52.4 (51.4–53.4) | −0.05 | 49.0 (47.4–50.7) | 50.6 (49.2–52.1) | 0.16 |
None | 22 | 46.8 (42.6–50.9) | 44.9 (41.2–48.5) | −0.19 | 47.7 (42.9–52.6) | 43.1 (37.5–48.7) | −0.39 |
Working status | 0.21 | ||||||
Worker | 632 | 51.7 (51.2–52.2) | 51.5 (51.0–52.0) | −0.04 | 49.2 (48.4–49.9) | 51.2 (50.5–52.0) | 0.07 |
Retired | 222 | 49.2 (48.3–50.1) | 47.6 (46.6–48.7) | −0.23 | 50.8(49.5–52.1) | 51.5 (50.0–53.0) | 0.20 |
House keeper | 181 | 48.9 (47.8–50.0) | 47.8 (46.6–49.0) | −0.15 | 44.9 (43.2–46.5) | 47.2 (45.5–48.9) | 0.26 |
Student | 65 | 51.6 (50.1–53.0) | 52.3 (51.0–53.6) | 0.12 | 47.0 (44.6–49.4) | 49.7 (47.6–51.8) | 0.41 |
Unemployed | 36 | 52.2 (50.5–53.9) | 51.1 (49.5–52.7) | −0.16 | 43.9 (41.1–46.7) | 48.7 (46.3–51.0) | |
Systemic diseases | |||||||
No | 933 | 51.3 (50.9–51.7) | 51.0 (50.6–51.5) | −0.04 | 48.5(47.9– 49.2) | 50.6 (50.0–51.3) | 0.20 |
Yes | 249 | 49.1 (48.1–50.0) | 47.5 (46.4–48.5) | −0.21 | 48.1 (46.8–49.5) | 49.6 (48.1–51.0) | 0.13 |
| |||||||
Clinical indications | |||||||
Ectasia/thinning | 721 | 51.7 (51.2–52.1) | 51.3 (50.8–51.7) | −0.07 | 48.4 (47.6–49.1) | 50.7 (50.0–51.4) | 0.23 |
All other indications | 502 | 49.5 (48.9–50.2) | 48.7 (48.0–49.4) | −0.12 | 48.4 (47.6–49.1) | 50.1 (49.0–51.1) | 0.14 |
Previous keratoplasties | |||||||
No | 1,020 | 50.9 (50.5–51.3) | 50.3 (49.8–50.7) | −0.09 | 48.3 (47.7–49.0) | 50.5 (49.8–51.1) | 0.20 |
Yes | 148 | 50.1 (48.9–51.3) | 49.4 (48.1–50.6) | −0.09 | 48.4 (46.5–50.2) | 49.5 (47.6–51.5) | 0.10 |
Previous ocular surgery ( | |||||||
No | 884 | 51.5 (51.0–51.9) | 50.8 (50.4–51.3) | −0.10 | 48.2 (47.5–48.9) | 50.5 (49.8–51.1) | 0.22 |
Yes | 284 | 48.8 (47.9–49.6) | 48.1 (47.0–49.1) | −0.09 | 48.9 (47.5–50.2) | 50.1 (48.7–51.5) | 0.10 |
Other ocular diseases | |||||||
No | 939 | 51.0 (50.6–51.5) | 50.6 (50.1–51.0) | −0.07 | 48.0 (47.4–48.7) | 50.2 (49.6–51.0) | 0.20 |
Yes | 257 | 50.0 (49.1–50.9) | 49.1 (48.2–50.1) | −0.12 | 49.4 (48.1–50.7) | 51.0 (49.7–52.3) | 0.15 |
Adverse reactions/complications ( | |||||||
No | 809 | 50.9 (50.4–51.4) | 50.7 (50.3–51.2) | −0.02 | 48.7 (48.0–49.4) | 50.9 (50.2–51.6) | 0.21 |
Yes | 188 | 51.6 (50.6–52.5) | 49.9 (48.8–51.0) | −0.24 | 47.3 (45.8–48.7) | 48.9 (47.3–50.6) | 0.16 |
BCVA§ ( | |||||||
≤2/10 | 922 | 50.7 (50.3–51.2) | 50.4 (49.6–50.5) | −0.10 | 48.5 (47.9–49.2) | 50.6 (49.9–51.3) | 0.20 |
3/10-4/10 | 188 | 50.8 (49.9–51.7) | 51.1 (50.2–52.0) | 0.04 | 48.6 (47.1–50.1) | 49.8 (48.2–51.3) | 0.11 |
5/10-7/10 | 76 | 51.7 (50.1–53.4) | 50.4 (48.8–52.0) | −0.18 | 46.8 (44.0–49.6) | 50.7 (48.4–52.9) | 0.31 |
≥8/10 | 5 | 52.1 (43.3–60.9) | 47.7 (37.5–57.9) | −0.62 | 50.9 (34.4–67.3) | 55.9 (48.1–63.7) | 0.38 |
*Negative values of ES indicate poorer SF-12 scores compared to baseline; §best corrected visual acuity.
One year after surgery, males considered their health status to be improved (20.2%), worse (16.6%), or unchanged (63.2%), compared to baseline. In the females group, the corresponding figures were 18.3%, 20.4%, and 61.3%.
Scores given by males were higher than scores given by females, both at baseline and after one year.
Meaningful differences were observed within both SF-12 summary component scores across the distribution of demographic and clinical variables (Table
Since the reliability of SF-12 summary scores is not assured for small numbers, results in categories with less than 100 cases should be considered with caution (i.e., some age groups, widow/divorced, no education, student, jobless, and visual acuity higher than 5/10).
For the patient sample as a whole, the mean PCS-12 remained unchanged (ES = 0.09) but variations of MCS-12 suggest improvement of HRQOL with a small magnitude of change (ES = 0.19). Considering males and females separately, transplantation did not influence physical health in males (PCS-12 ES = −0.01) and had a negative effect in females (PCS-12 ES = −0.18). However, mental health improved in both genders after one year (MCS-12 ES = 0.18 and 0.23, resp.).
As far as patients’ age is concerned, PCS-12 showed slight changes while MCS-12 increased after transplantation in several age intervals of both genders.
Physical health was not affected by almost all demographic and socioeconomic variables or decreased only in some cases (married people, people with low level of education, and retired people) with negative ES values ranging from 0.16 to 0.23. On the other hand, mental health substantially increased, with positive MCS-12 ES values from 0.16 to 0.28.
Systemic diseases and AE/C reported in follow-up were associated with a poorer PCS-12 after corneal transplantation (ES = −0.21 and −0.24, resp.) but all health and eye-related variables correlated positively with increased MCS-12 values at one year (ES ranging from 0.10 to 0.23).
The majority of patients were satisfied with the graft and would decide to undergo surgery again. They considered their graft had been worthwhile (Table
Patients’ expectation and satisfaction.
Questions | Yes | No | Uncertain |
---|---|---|---|
(1) Are you happy with your graft outcome? | 1,016 (83.1) | 144 (11.8) | 63 (5.1) |
(2) Does the outcome match your expectation? | 864 (70.6) | 293 (24.0) | 66 (5.4) |
(3) Would you make the same decision again? | 1,100 (90.0) | 65 (5.3) | 57 (4.7) |
(4) Was having the graft worthwhile? | 1,170 (95.7) | 27 (2.2) | 26 (2.1) |
(5) Have you had more complications than you expected? | 271 (22.2) | 948 (77.5) | 4 (0.3) |
No differences were found in the satisfaction with graft outcome between genders (
Distributions of answers to the sixth item of the questionnaire (
Overall patients’ satisfaction.
Males | Females | Total | |
---|---|---|---|
Completely | 411 (57.2) | 268 (53.2) | 679 (55.5) |
Quite | 217 (30.2) | 166 (33.0) | 383 (31.3) |
None | 68 (9.5) | 58 (11.5) | 126 (10.3) |
Uncertain | 23 (3.1) | 12 (2.3) | 35 (2.9) |
Total | 719 (100.0) | 504 (100.0) | 1.223 (100.0) |
As assessed in the SF-12 validation study on more than 61,000 subjects [
In the same study, about 30,000 healthy subjects reported PCS-12 values of 53.7 (6.0) and MCS-12 of 52.8 (7.9). As expected, diseased patients showed clear decreases of both summary components, with PCS-12 scores ranging from 45.9 (11.0) to 37.2 (11.1) in patients with migraine and past stoke and MCS-12 scores ranging from 46.0 (11.5) to 33.8 (10.8) in patients with prostatic hypertrophy and central nervous system pathologies, respectively. In the present study, patients waiting for corneal transplantation showed PCS-12 of 50.8 (6.9) and MCS-12 of 48.4 (10.5) with SF-12 values lower than those of healthy population in both genders (Table
This is the first report on the use of the SF-12 Health Survey in corneal transplantation and one of the few longitudinal studies that have assessed changes in the HRQOL in patients who have undergone corneal grafting. The study showed that the graft improves patients’ HRQOL and influences mental health more than physical health.
Consistently with almost all the surveys using the HRQOL, females showed poorer quality of life scores than males. Moreover, our study showed that physical health in females was negatively affected by corneal transplantation while grafts in males did not change the PCS-12 baseline values.
Since no difference in graft outcomes is expected between the genders and satisfaction with grafts was the same for males and females, the inconsistency of PCS-12 results could highlight differences in perceptions between the sexes with respect to the impact of grafting on physical health. Actually, there are no obvious reasons why young or middle-aged patients—that generally maintain a normal life style, with minor limitation, while waiting for surgery—should have reduced their physical health after the graft.
Conversely, the significant improvement of mental health in both sexes shows that although the graft primarily aims to improve visual function, corneal transplantation largely affects psychological and emotional aspects of self-perceived health.
This result parallels the recent finding by Kymes and coworkers [
The restoration of sight is the most important purpose of corneal grafting. However, since successful corneal transplantation can improve both health and lifestyle of patients, their personal feelings should be considered as a central issue in their overall assessment.
Health-related quality of life
12-item short-form health survey
Penetrating keratoplasty
Anterior lamellar keratoplasty
Physical component summary
Mental component summary
Effect size.
The authors would like to thank patients, ophthalmic surgeons, and personnel in the clinical centers for their cooperation and Professor K. A. Williams for the permission to use the satisfaction questionnaire. The role of Fondazione Cassa di Risparmio di Padova e Rovigo and the Veneto Eye Bank Foundation, which funded the research, is also acknowledged. The authors acknowledge the corneal transplant epidemiological study group (CORTES) for their contribution to the paper.