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Amira Stylianides, Conor C. Murphy, Mark N. Jones, Rosalind M. Stewart, Stephen B. Kaye; Mortality and Graft Survival of Patients Receiving Penetrating Keratoplasty for Rheumatoid Arthritis associated Corneal Disease. Invest. Ophthalmol. Vis. Sci. 2011;52(14):354.
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To determine whether patients with rheumatoid arthritis (RA) receiving penetrating keratoplasty (PK) for RA associated corneal disease have an increased mortality rate compared to non-RA patients receiving PK and to RA patients without corneal disease, and to compare graft survival in this group compared to patients requiring PK for non-rheumatoid corneal disease
All patients registered on the UK Transplant Registry with RA undergoing first PK between 01/04/1999 and 01/04/2006 were included. An age-matched control group of patients undergoing PK for Fuchs’ dystrophy or pseudophakic bullous keratopathy (PBK) over the same time period was also included. Patient outcome data was collected from UK ocular tissue transplant audit follow-up forms.
Patients receiving PK for RA associated corneal disease had a 5 year patient survival rate of 50% compared with 84% for Fuchs’ dystrophy and 70% for PBK. Standardised mortality ratios (SMR) showed male RA patients receiving a PK were 12.2 times more likely to die compared to the general population (95% CI 7.1 - 19.5) and females were 42.6 times more likely to die (95% CI 25.2 - 67.3), in comparison to SMR’s of 1.45 for males and 1.84 for females in the general RA population. Infection was the commonest cause of death in RA patients receiving PK (34%). Patients with PK for RA associated corneal disease had a 40% 5 year graft survival rate compared with 54% for PBK and 82% for Fuchs’ dystrophy. Commonest causes of graft failure in RA patients were infection (38.2%) and recurrence of original disease (20.6%). Main causes of graft failure in Fuchs’ dystrophy and PBK patients were endothelial decompensation and graft rejection
Both graft and patient survival were significantly lower in RA patients compared with Fuchs’ dystrophy and PBK. Patient survival was significantly reduced compared with RA patients with no corneal disease and to the general population. Development of corneal disease and the higher mortality rate in these patients may reflect a potentially lethal active systemic vasculitis that requires control particularly at time of transplant. The identification of these patients having a high risk of graft failure particularly as a result of infection may lead to measures to reduce this complication
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