Abstract
Abstract: :
Purpose: To evaluate the current management and clinical outcomes of consecutive corneal transplant patients in a single centre in the United Kingdom (UK). Methods: This was a prospective, single–centre, consecutively enrolled registry of all patients receiving penetrating keratoplasty (PKP), between February 1997 and August 2002, at the Royal Victoria Infirmary, Newcastle upon Tyne, UK. Pre–operative recipient information and annual follow–up data were analysed. Improvement in visual acuity was analysed by logistic regression methods. Unadjusted graft survival rates were obtained from Kaplan–Meier estimates. Results: Two hundred and sixty–seven PKPs were reported in the analysis, including 34 bilateral transplants. 124 (53%) recipients were male and 105 (39%) grafts were regarded as high risk. The main desired outcome in 83% of grafts was to improve visual acuity. 93% of the grafts were performed as elective surgery. The major diagnostic categories were Fuchs’ endothelial dystrophy and stromal dystrophies (21%), bullous keratopathy (19%), keratoconus (13%) and regraft (13%). 78% of grafts improved by at least one line of visual acuity post–operatively, compared with 12% that decreased and 10% that remained unchanged. Three–year graft survival was 88% (95% CI 82–93) and in total 27 (10%) grafts failed, 10 (37%) due to irreversible rejection and 12 (45%) due to endothelial decompensation. Multiple logistic regression analysis regarding corneal graft success (at least 3 lines of improvement using Snellen acuity recordings after 12 months) of 149 grafts (38% success) found a statistically significant effect of two pre–operative factors. Odds of success were greater for size–matched donor and recipient (3.4, 95% CI 1.1–10.4) than for size mismatched corneas (>0.25mm), p=0.03. The presence of an intra ocular lens was also associated with greater success (odds ratio 2.5, 95% CI 1.2 – 5.1), p=0.01. Conclusions: The best improvement in visual acuity after corneal grafting is obtained in keratoconus and bullous keratopathy; and when the difference between donor and recipient size is small (0.25mm). This registry offers a unique opportunity to analyse the long–term outcomes of corneal transplantation in a UK ophthalmic unit. It also provides the opportunity to analyse relationships between different outcome measures in corneal grafting, and to observe how these evolve as a result of an established post–operative management protocol, but also to refine the criteria for patient selection and to guide clinical practice.
Keywords: cornea: clinical science • transplantation • clinical (human) or epidemiologic studies: outcomes/complications