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Corneal transplantation: how successful are we?
  1. W J ARMITAGE and
  2. J M CREWE
  1. Division of Ophthalmology, University of Bristol
  2. Bristol Eye Hospital, Bristol BS1 2LX, UK
  3. Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WH, UK
  1. A B TULLO
  1. Division of Ophthalmology, University of Bristol
  2. Bristol Eye Hospital, Bristol BS1 2LX, UK
  3. Manchester Royal Eye Hospital, Oxford Road, Manchester M13 9WH, UK
  1. W J Armitage w.j.armitage{at}bristol.ac.uk

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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. Moreover, in the present climate of clinical audit and evidence based medicine, the collection of such data has surely become a necessity.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 organised, centralised data collection and analysis, for example.

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 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 1 year follow up as in the original CTFS, 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 with an independent confidential analysis of clinical outcomes, which they will increasingly be expected to have available.

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