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F.C. Figueiredo, W. Adams; Analysis of Outpatient Clinic Non-attendance in Patients after Corneal Transplantion . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4701.
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Purpose: Preoperative counselling for keratoplasty includes informing the patient of the need for regular attendance at the corneal clinic post operatively. This study was designed to examine the characteristics of frequent non-attendees at the corneal clinic. This data should enable the corneal service to be modified to suit the patients' needs. Methods: A retrospective review of all case records of patients that failed to attend the corneal transplant service > 3 times post penetrating keratoplasty was performed. In addition each patient was contacted by telephone to discuss his or her lack of attendance. Results: Twenty-seven patients (10.5 %) from a total population of 257 (grafts performed from February 1997 to June 2002) were found to be frequent non-attendees. Median age of 44 years (range 25-95) of which 55.5 % were less than 50 years. 100% were Caucasian and 66% were male. Out of this group 40.7 % had keratoconus, 22% had aphakic/pseudophakic bullous keratopathy and 14.8% had herpes simplex keratitis as the original pathology. Ten patients were married the rest were either single or widowed. The mean length of time post operatively to first non attendance was 9 months (range 1-40). The mean number of appointments missed was 5.3 (range 3-14). The mean distance from the hospital is 23.4 miles (range 3-130). One hundred and thirty five (93 %) appointments missed were in the morning. 44 % of the patients had visual acuity > 6/12 in the grafted eye and 59 % had visual acuity > 6/12 in the other eye. Reason for non-attendance was asked when contacted by telephone and 22% had ill health and 22 % found the travelling distance a problem. Conclusions: Frequent non attendance at clinic after keratoplasty is concerning with respect to surgical complications and risk of rejection. This data shows that those patients living a considerable distance from the central hospital are highly likely to fail to attend, especially a morning appointment. A large proportion are young, single, male keratoconics with excellent vision who are working so find it hard to fit clinic visits into their lifestyle. In order to anticipate these problems the corneal transplant service may have to offer more flexibility in appointment times with evening clinics a possible option. These patients are more likely to attend a local hospital, so discharge back to the local hospital once stable, may be recommended. A large proportion failed to attend prior to their keratoplasty so more emphasis during pre operative counselling is necessary to ensure they understand the importance of attendance.
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