‘Follow-up of corneal transplant patients declining’

Sees a dropout rate of 78%, finds LV Prasad Eye Institute study

Hyderabad: In the last few years, thanks to rapid strides made in medical technology, corneal transplants have become relatively safer with fewer complications. Despite these developments, there is always a risk of rejection of the graft, which makes regular follow-ups for patients with corneal transplants necessary.

However, researchers at LV Prasad Eye Institute (LVPEI) in a recent study reported that followup of patients who underwent corneal transplants is declining. The study on the lack of follow-up among corneal transplant patients holds a lot of relevance for the government corneal transplantation programme at SD Eye Hospital, where the surgery is offered free of cost to patients. In the retrospective study by Dr Sujata Das and others from LV Prasad Eye Institute (LVPEI), the researchers reported a 78 per cent drop-out rate and also identified factors that are associated with the heavy dropout of patients. The study split 163 patients (165 eyes) at LVPEI in Bhubaneswar, who underwent corneal transplantation into two groups: those who adhered to follow-up visits over a 3-year period and those who did not.

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The cohort’s median age was 52 (maximum 65 years) and a majority (67.5%) were male. For about 23 per cent of the patients, the transplanted eye was the only functional eye. At the threeyear mark (36 months), 129 eyes (78.2 per cent) were in the ‘lost-to-follow-up’ group, the researchers in the study, which was published in the Indian Journal of Ophthalmology (IJO), said. Beginning at 68 per cent at 6 months, the follow-up rate fell to 35.2 per cent by the third year in this cohort. The loss to follow-up in this cohort then is the highest recorded in literature from low-income countries on corneal transplant outcomes, researchers said.

The study found that older age, prior graft failure, and poorer visual acuity in the last visit had a strong association with dropping out of follow-up. Longer distances from the hospital also had a strong association with the drop-off rate. Many factors seem to influence the behaviour of dropping out of follow-up. In therapeutic transplants, patients may not see any big improvement in vision, and this may be disappointing. There may be financial or logistical barriers that prevent patients from coming back for a follow-up. A failed transplant may itself result in a loss of followup.

Through the study, the researchers have raised many important questions on what it takes to bring people back to the clinic and have also offered a few solutions like tele-ophthalmic follow-up.