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C. C. Murphy, M. N. A. Jones, R. Stewart, M. Batterbury, S. B. Kaye, Ocular Tissue Advisory Group, UK Transplant; Prospective Study of the Long-Term Outcome of Penetrating Keratoplasty for Rheumatoid Arthritis Associated Corneal Ulceration. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2310.
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To investigate transplant and patient survival following penetrating keratoplasty (PK) for rheumatoid arthritis (RA) associated corneal ulceration in the United Kingdom.
All patients registered with United Kingdom Transplant (UKT) undergoing PK for RA associated corneal ulceration between April 1999 and May 2006 were included. Clinical and demographic data were prospectively recorded using audit reporting forms completed at surgery and at one, two and five years post-operatively. Data pertaining to the number of transplants performed, number of transplant rejection episodes, transplant failure and its causes, visual acuity, astigmatism and patient survival were analyzed. Kaplan-Meier survival curves were used to compare five-year transplant and patient outcomes with first PK for Fuchs’ endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK). Further clinical details were requested for all transplant failures via a postal questionnaire to the patients’ corneal specialists.
153 PK were performed in 142 patients for RA associated corneal ulceration during the study period. Follow up data pertaining to the 117 first PK in this cohort were available in 106 cases (91%). The mean (SD) follow up for first PK for RA was 18 (18) months. Mean patient age was 69 years and 69% of the patients were female. Median best-corrected visual acuity improved from hand movements pre-operatively to 20/120 in surviving transplants and counting fingers in failed transplants at the last reported follow-up post-operatively. Survival of first PK was 40% at 5 years for RA and this was significantly lower (p < 0.0001) than for PBK (54%, n=1700) and FED (82%, n=1846). The main causes of failure were acquired infection (38%), recurrence of corneal melt (21%), endothelial failure (12%) and irreversible rejection (6%). Patient survival 5 years after the first PK was 50%, which was significantly lower (p < 0.0001) than PBK (70%) and FED (84%).
This study highlights the relatively poor outcome of PK in patients with RA associated corneal ulceration with respect to visual acuity and transplant survival compared with PBK and FED and brings attention to the poor five-year patient survival of this cohort.
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