Abstract
Purpose :
This study aims to evaluate the survival and the clinical and demographic factors associated with repeat corneal grafts in a tertiary eye service in the UK.
Methods :
The Newcastle Corneal Transplant Registry (NCTR) is a database containing information on graft donors, recipients, operation details and follow-up data. Survival analysis was performed using the Kaplan-Meier method. Multivariate Cox proportional hazard regression was performed to analyse factors associated with graft failure.
Results :
This study comprised 156 consecutive corneal grafts performed under a single surgeon over a period of 17 years (Mar 1997 – Jul 2014). Median follow-up was 49.5 months (range: 2-193 months). Males comprised 53.8% of patients. The mean age at transplant was 65.0 years (SD 17.2 years; range 1 – 94 years). Overall survival at 1, 5, 10 and 15 years (with 95% CIs) was 100% (100 – 100%), 71.9% (63.6 – 81.4%), 48.0% (37.0 – 62.2%) and 18.9% (9.59 – 37.1%), respectively. Only eight (5.12%) re-grafts reached 10 years follow-up . Neovascularisation was the only graft risk factor associated with worse graft survival (Hazard Ratio=13.2 (1.19–146), p=0.036). Increasing number of quadrants bearing superficial vessels was associated with worse survival (HR=1.32 (1.03-1.68), p=0.027). Original pathology (infection, injury, ectasia, dystrophy or previous ocular surgery) did not significantly affect graft survival (HR = 0.39 (0.13-1.19), 2.17 (0.72-6.49), 0.26 (0.06-1.18), 0.46 (0.14-1.50), 1.47 (0.60-3.58); p=0.10, 0.17, 0.08, 0.20, 0.39, respectively), although ectasias appeared to have the best overall survival.
Conclusions :
Re-grafts are capable of long-term survival. Neovascularisation is an important prognostic indicator of graft failure and can be quantified by the number of quadrants affected by superficial vessels, in our study. This study highlights the importance of neovascularisation as a putative cause of graft failure in re-grafts.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.