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Sing-Pey Chow, Mark N Jones, Frank Larkin, Fiona Carley, Stephen B Kaye, Francisco C Figueiredo, George Smith, Derek Tole; Ten-Year Follow-Up of Graft Survival and Visual Outcomes Following Penetrating Keratoplasty in the United Kingdom. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6199. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Graft survival following penetrating keratoplasty (PK) is known to decrease with time. Ten-year graft survival range from 50% to 82% in single-center series but national graft registry data that may better reflect ‘real world’ outcomes is scarce. We report 10-year graft survival and visual outcomes after primary PK in the United Kingdom (UK) using the UK Transplant Registry.
All primary PK in the UK from 1 April 1999 and 28 February 2003 (n=4876) were grouped by indication: (i) Keratoconus (KC), (ii) Fuchs endothelial dystrophy (FED), (iii) pseudophakic/aphakic bullous keratopathy (PACE) and (iv) others (comprising all infections, interstitial keratitis, immune-related ulcerative keratitis and other dystrophies). 702 ten-year follow-up forms were issued to ophthalmologists in a pilot study; 68% were returned. 460 were matched to a transplant record form from surgery; 275 were primary PKs. Grafts not in the pilot were included in survival estimates until last reported follow-up up to 5 years; Kaplan-Meier plots were extended to 10 years for grafts within the pilot study.
Graft survival for primary PK for all indications was 75% (95% CI 74-77) at 5 years and 68% (95% CI 66-71) at 10 years. Graft survival for KC (n=1266), FED (n=1005), PACE (n=949) and others (n=1656) was 89%, 80%, 48% and 58% respectively. Mean age at transplantation (years) was 31 (SD 10.9) for KC, 72 (SD 10.6) for FED, 75 years (SD 11.0) for PACE and 61 (SD 19.5) for others. 48.6% were female; 50% were right-sided.Of the 275 primary PKs with a completed 10-year follow-up form, 62% still attended clinic. Of those no longer attending clinic (n=105), 52% and 93% of the FED and PACE groups had died. 35 grafts (13%) had failed at 10 years, mainly due to endothelial decompensation (n=14; 48%).Of those with pre-operative and 10-year best corrected visual acuity (VA) (n=137), the proportion of patients with Snellen VA 6/12 or better was significantly higher for all indications, from 9% to 91% in KC (p<0.0001), 35% to 69% in FED (p=0.03) and 0% to 60% in PACE (p=0.0003). Mean VA was not significantly different between 2 years and 10 years for all indications (p>0.05).
Ten-year graft survival for primary PK in the UK was 68%; grafts for KC and FED had more favourable survival rates. Significant improvement in VA occurred after primary PK for all indications, mostly within the first 2 years.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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