ORCID Profile
0000-0002-7921-8963
Current Organisation
The University of Auckland
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Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2005
DOI: 10.1097/01.ICO.0000155035.55751.B2
Abstract: To evaluate donor demographics and source, donor tissue processing and storage, biologic contamination, and the utilization and distribution of corneal tissue procured by the New Zealand National Eye Bank. As part of a prospective longitudinal study, the electronic records of the NZNEB for the 13-year period 1991-2003 were analyzed for each year with respect to donor demographics, donor source and cause of death, death-to-preservation interval, storage methods, endothelial assessment, biologic contamination, corneal tissue utilization, and distribution. During the study period, 3221 corneas were retrieved from 1628 donors (69.8% male, 30.2% female), with the mean age of donors 59.4 years (SD 18.3 years) and range 4 to 95 years. No significant correlation was identified between donor age group (using 10-year intervals) and the proportion of corneas suitable for transplantation. Donors were procured from the Coroner's service (67.6%), public hospitals, (23.5%) and multiorgan donors (7.1%). The most common causes of donor death were cardiovascular disease, trauma, and cerebrovascular disease. Average storage duration increased from 3.5 to 11.8 days when organ culture replaced hypothermic storage in 1992. Biologic contamination occurred in 5% of all donor corneas. The most common bacterial and fungal isolates were coagulase-negative staphylococci and Candida spp, respectively. A significant decrease in contamination rate over the years of the study was identified. Overall, 79.4% of corneal tissue procured was used for corneal transplantation (75.8% for penetrating keratoplasty, 2.1% for lamellar keratoplasty, and 1.5% for unspecified transplants), and 21.6% was discarded. Most common reasons for discarding tissue were biologic contamination, abnormal serology, and failed endothelial assessment. Analysis of the NZNEB database provides valuable information in relation to eye banking and corneal transplantation in New Zealand. Significant trends were identified in donor demographics, donor procurement source, improved donor tissue processing and storage, decreased biologic contamination, and increased utilization of corneal tissue.
Publisher: BMJ
Date: 15-09-2017
DOI: 10.1136/BJOPHTHALMOL-2016-309021
Abstract: To report the 25-year longitudinal trends in indications and corneal transplantation techniques in New Zealand. Statistical analysis of prospectively acquired New Zealand National Eye Bank (NZNEB) electronic database from 1991 to 2015 inclusive. Subjects were recipients of corneal transplants in 62 centres supplied by the NZNEB. Main outcome measures were indications, recipient age and transplantation techniques. From January 1991 to December 2015, NZNEB supplied tissue for 5574 corneal transplants, increasing annually from 89 (1991) to 290 (2015). Penetrating keratoplasty remained the most commonly performed technique throughout the 25-year period, although it decreased from 98.9% of all transplants in 1991 to 60.3% in 2015. There was a corresponding increase in deep anterior lamellar and endothelial keratoplasty over the most recent decade from 2.5% to 7.2% and 4.9% to 31.4%, respectively. Keratoconus remained the leading indication for keratoplasty through to 2015 (34.5%). Regrafts (23.1%) and Fuchs endothelial corneal dystrophy (17.0%) have become more common indications, while bullous keratopathy has become less common (10.8%). There was a bimodal distribution in age with peaks at 20-29 and 60-79 years. There was a reduction in recipients under age 40 and corresponding increase in the percentage of recipients aged 40-69. Changing indications and increasing uptake of lamellar keratoplasty have been significant international trends over the last 25 years. However, New Zealand's corneal disease and population characteristics create unique longitudinal trends, with keratoconus remaining the leading indication and penetrating keratoplasty the leading technique from 1991 to 2015.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2002
DOI: 10.1097/00003226-200203000-00004
Abstract: To identify the indications for keratoplasty in patients supplied with donor tissue through the New Zealand National Eye Bank. Analysis of penetrating and lamellar keratoplasty data collected by the New Zealand National Eye Bank, Auckland, from 1991 to 1999. In this 9-year period, donor material was supplied for 1370 corneal grafts 1308 for penetrating keratoplasty, 26 for lamellar keratoplasty, and 36 for unspecified grafts. This accounts for a minimum of 85% of the penetrating keratoplasties performed in New Zealand from 1991 to 1999. The leading indications for penetrating keratoplasty were keratoconus (45.6%), pseudophakic or aphakic corneal edema (17.9%), regraft (8.7%), viral keratitis (7.3%), and trauma (5.5%). The average age of patients was 47.5 years (SD = 22.6) and age distribution was bimodal, with peaks in the 3rd and 8th decades. Keratoconus, regraft, and trauma were significantly more common as indicators for penetrating keratoplasty in male patients than female patients however, pseudophakic or aphakic corneal edema was more common in female patients. The majority of transplantation surgery in New Zealand is performed using corneal tissue from the New Zealand National Eye Bank. In this representative study, keratoconus is the leading indicator for penetrating keratoplasty in New Zealand, accounting for a higher proportion than in any other published literature. The other indications, age distribution and gender differences correlate with previous reports. These findings suggest that keratoconus leading to transplantation may have increased prevalence in New Zealand.
Publisher: BMJ
Date: 04-2005
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2012
Publisher: Wiley
Date: 04-2012
Publisher: Wiley
Date: 04-2006
DOI: 10.1111/J.1442-9071.2006.01202.X
Abstract: A 54-year-old man with a history of severe proliferative diabetic retinopathy in both eyes and profound visual impairment presented with severe corneal blood staining in the left eye secondary to a "spontaneous" total hyphaema and raised intraocular pressure in an eye with iris neovascularization. Despite anterior chamber washout, the cornea remained virtually opaque and thickened. The subject subsequently underwent pars plana vitrectomy with endolaser using a temporary keratoprosthesis, insertion of a Morcher iris-surround intraocular lens and penetrating keratoplasty. Histopathology of the excised corneal button revealed fine eosinophilic granules composed of aggregations of haemoglobin and its breakdown products dispersed throughout the stroma, with occasional foci of weakly positive Perl staining for intracellular haemosiderin. Fluorescence confocal microscopy revealed a marked increase in fluorescence throughout the corneal stroma and the basal epithelial layer. This case highlights the microstructural features and aspects of the surgical management of severe corneal blood staining.
Publisher: Wiley
Date: 04-11-2012
DOI: 10.1111/J.1442-9071.2011.02681.X
Abstract: To investigate the indications for corneal transplantation and the distribution of donor corneal tissue in New Zealand. Analysis of the prospective database of the New Zealand National Eye Bank. A total of 2205 corneal transplants were assessed. New Zealand National Eye Bank records were analysed for the decade 2000-2009. Variables analysed included donor corneal tissue distribution (including public and private sectors), indications for transplantation, donor corneal tissue recipient demographics (age and gender) and corneal transplantation type. An average of 220 corneal transplants were performed each year over the 10-year period (n=2205). The median recipient age was 45years (range 3 to 102years) and 54.0% of recipients were male. In total 71.8% of transplants were performed in the public health sector. Surgeons in the Auckland metropolitan area performed 47.2% of all corneal transplants. The most common indications for corneal transplantation were: keratoconus (41.1%), repeat transplant (17.0%), aphakic seudophakic bullous keratopathy (13.9%), corneal dystrophy (10.7%), keratitis (7.9%) and trauma (3.7%). Overall, penetrating keratoplasty accounted for 90.7% of all corneal transplants, however, during the latter half of the study there was a progressive shift in transplantation type, with deep anterior lamellar keratoplasty and Descemet's stripping endothelial keratoplasty combined accounting for 32.3% of all transplants in the final year of the study period. This New Zealand National Eye Bank study provides valuable data regarding the indications for corneal transplantation, transplant recipient demographics and changes in transplantation type in New Zealand over the past decade.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2011
Publisher: Wiley
Date: 22-07-2019
DOI: 10.1111/CEO.13581
Abstract: In New Zealand, repeat keratoplasty has become the second leading indication for corneal transplantation. To report the indications, outcomes and survival of repeat keratoplasty and evaluate the risk factors for graft failure. Retrospective study in a public corneal service. Two hundred nineteen patients undergoing 279 repeat keratoplasty procedures during 1991-2017. The New Zealand National Eye Bank prospectively collects data on all corneal transplants. This was utilized to identify patients undergoing repeat keratoplasty in Auckland. Clinical records were retrospectively reviewed. Graft survival and visual outcome. The repeat keratoplasty technique was penetrating keratoplasty (PK) in 242 cases (86.7%) and endothelial keratoplasty in 37 (13.3%). The most common primary indication was keratoconus (46.6%). The most common indication for repeat keratoplasty was endothelial decompensation (37.6%). For PK performed as a repeat keratoplasty, the median survival in years was 12.0 for first, 3.5 for second and 2.3 for third repeat keratoplasty. Keratoconus had the longest graft survival (median 13.0 years). In surviving grafts, median visual acuity was 6/15 at 1 year and 6/12 at 2 years. On multivariate analysis, regraft number (P = .022), non-European ethnicity (P = .007), concurrent surgical procedure (P < .0005), lower donor endothelial density (P = .028), previous glaucoma surgery (P < .0005), postoperative raised intraocular pressure (P = .001) and graft rejection (P = .032) were associated with keratoplasty failure. Repeat keratoplasty survival is affected by multiple interacting factors and prognosis worsens with each subsequent regraft. These results will help guide clinicians in addressing patients' in idual risk factors when embarking on repeat corneal transplant surgery.
No related grants have been discovered for Nigel Brookes.