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Elaine McElhinny, Julia Fullerton; Distance to surgery center and graft failure in penetrating keratoplasty for keratoconus. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5669.
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© ARVO (1962-2015); The Authors (2016-present)
To determine:1) Do patients who live at increased distance from the surgery center have increased rates of graft failure/rejection or worse visual outcomes?2) What factors affect graft failure?
This was a retrospective chart review of Virginia Commonwealth University Hospital records from 1996-2016. Patients were identified by icd-9 coding for corneal transplant (v42.5). Statistical analysis used SPSS. This research was approved by the hospital office of research subject protection.
29 patients (35 eyes) of 196 patient charts reviewed had penetrating keratoplasty (PKP) for keratoconus. 6 patients (6 eyes) had at least one failed PKP. 20 patients (23 eyes) had at least one clear PKP. Graft failure was diagnosed at average 8 months (range 1-22) and etiology of failure included spastic entropion (1), medication noncompliance (1), endothelial rejection (2) , elevated intraocular pressure (1), and stromal thinning/inferior ectasia (1). Follow up in the clear graft group ranged from 12-276 months. Age and sex were not significantly different between the clear graft and graft failure groups. Average distance from surgery center was 28 miles (range 5-116) in the clear graft group and 46 miles (5-102) in the graft failure group but was not significantly different (p 0.14). All patients in the graft failure group had a previous failed PKP compared to 14% of the clear graft group (p<0.001). Patient cancellation and no show rates were not worse in the graft failure group with 50% of clear graft patients and 33% of graft failure patients having at least one cancellation. Patients who lived further from the hospital were not more likely to miss appointments. All graft failure patients had insurance, while 3 patients in the clear graft group were self pay for some of their visits. Vision in the clear graft group ranged from logMAR 0 to -3 with mode of -0.2 and 52% achieving vision of -0.3 or better, with glaucoma diagnosis for patients with the worst vision. No trend to worsening vision and further distance from surgery center was noted.
In this population, greater distance from surgery center was not associated with graft failure or worse visual outcomes. Previous graft failure was strongly associated with repeat graft failure. Access to resources may be a more important factor in corneal transplant success than distance.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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