Editor,
The commentary by Waldock and Cook on the survival rates of corneal grafts highlights a number of issues. In particular, they focus on the lack of long-term follow-up data in the UK. The value of such data is clearly evident from the Australian Corneal Graft Register.[1] Moreover, in the present climate of clinical audit and evidence-based medicine, the collection of such data has surely become a necessity.[2] Many of the questions raised, whether simply comparing graft survival rates of individual units with national data or investigating more fundamental issues such as HLA matching, visual outcome or surgeon experience, require large amounts of data, properly designed studies and appropriate statistical analysis-capabilities beyond most individual centres, but readily achievable within the NHS. The way forward as shown by the organ transplant community, and to a certain extent by corneal graft surgeons, is through well-organized, centralized data collection and analysis. e.g.[1] [3] [4]

The good news is that just such a system is now in place for all corneal graft surgeons in the UK. The Royal College of Ophthalmologists and the UK Transplant (UKT) have initiated an Ocular Tissue Transplant Audit, which will provide the data for answering the sorts of questions posed by Waldock and Cook. Indeed, the Audit is already being used for data capture for the Corneal Transplant Follow-up Study II, which aims to resolve the uncertainty surrounding HLA-DR matching and corneal graft rejection. Instead of just one-year follow-up as in the original CTFS,[4] follow-up for these patients will continue in the long-term through the Audit.

As important, however, is the opportunity for all ocular tissue transplants to be recorded and the outcome audited. Indeed one can foresee the day when this will be obligatory, as is the case with solid organs. To record such data with UKT will not only provide surgeons with details of their own activity, but an independent confidential analysis of clinical outcomes, which they will increasingly be expected to have available.

References
1. Williams KA, Muehlberg SM, Lewis RF, et al. The Australian corneal graft registry 1996 report. Adelaide: Mercury Press, 1997.
2. Coster DJ. Evaluation of corneal transplantation [editorial]. Br J Ophthalmol 1997;81:618-619.
3. United Kingdom Transplant Support Service Authority Renal Transplant Audit 1984-1993. Bristol: UKTSSA, 1995.
4. Vail A, Gore SM, Bradley BA, et al. Conclusions of the corneal transplant follow-up study. Br J Ophthalmol 1997;81:631-6.