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Francisco C Figueiredo, Ali Essam Ghareeb, Maria Socorro Figueiredo, Wayne John Armitage, Sayali Pradhan; The Newcastle Corneal Transplant Registry: 15-year outcomes of the first corneal transplantation. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6278.
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To evaluate the demographics and long-term clinical outcomes of patients undergoing first corneal transplantation in the form of penetrating keratoplasty (PKP) and deep anterior lamellar keratoplasty (DALK) in a single tertiary centre in the UK.
The Newcastle Corneal Transplant Registry (NCTR) is a prospective, single centre, non-comparative, interventional case series of transplants performed under a single surgeon. We have analysed the demographic and long-term clinical outcomes in 549 consecutive corneal transplants, over a period of 18 years (Feb 1997–Jun 2015), in patients undergoing transplantation for the first time. Survival analysis was performed using the Kaplan-Meier method and analysis of covariates by a Cox proportional hazards regression model.
This study comprised 548 consecutive corneal grafts (528 PKPs and 20 DALKs) performed under a single surgeon. Median follow-up was 69 months (range: 2-205 months). Male patients comprised 51.1% of patients. The mean age at transplant was 58.2 years (SD 22.7 years; range 0 – 99 years). The most common aetiologies were dystrophies (n=182, 34%), ectasias (n=127, 23.7%) and previous ocular surgery (n=102, 19.0%). The most common graft size was 7.75 mm. Overall survival at 1, 5, 10 and 15 years (with 95% CIs) was 99.2% (98.5 – 100%), 92.1% (89.5% - 94.8%), 75.6% (70.3 – 81.3%) and 56.8% (47.9 – 67.4%), respectively. Planned procedures had better survival compared to emergency procedures (Hazard Ratio=0.35 (0.14-0.88), p=0.026). Neovascularisation predicted poor graft survival (HR=2.94 (1.26-6.86), p=0.013). Those patients whose original pathology was previous ocular surgery (n=102) had the shortest graft survival (HR=3.45 (1.13-10.5), p=0.030). In 82 of these patients, the indication for transplant was pseudophakic corneal oedema.
The corneal survival rate was dependant on indication and our graft survival is comparable to other studies. This registry offers a unique opportunity to analyse the long-term outcomes of corneal transplantation in a tertiary hospital in UK. It offers the opportunity to study relationships between different outcome measures in corneal grafting, and to observe how these evolve as a result of an established post-operative management protocol. This ultimately helps to refine the criteria for patient selection and to guide clinical practice to improve visual outcomes and graft survival.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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