Centre-Specific Variation in Corneal Transplant Outcomes in the United Kingdom

Background. To examine the influence of center or surgeon transplant workload on corneal transplant outcome. Methods. In this database study, centers were categorized as high or low volume if registering more than 50 and less than 10 corneal transplants per year, respectively; surgeons were categorized as high or low volume if registering more than 30 and less than 10 transplants per year, respectively. The participants were patients aged at least 17 years receiving a first penetrating keratoplasty for keratoconus, Fuchs' endothelial disease, or pseudophakic corneal edema in a 7-year period from 1999 in (1) high-volume (n=1724) and low-volume (n=2131) centers and (2) under care of high-volume (n=1332) and low-volume (n=1949) surgeons. Main outcome measures were (1) graft survival at 5 years and (2) 2-year posttransplant best-corrected and day-to-day visual acuity and astigmatism. Results. No significant difference in graft survival was found according to center or surgeon workload. Statistically significantly better day-to-day visual acuity was found only in patients with Fuchs' endothelial disease managed by high-volume surgeons (20/40 or better in 50% vs. 42% for low-volume surgeons). There was statistically significantly better best-corrected visual acuity in high-volume centers for Fuchs' endothelial disease and pseudophakic corneal edema and for high-volume surgeons in all disease groups. Conclusions. Based on this national transplant cohort, when analyzed according to center volume or surgeon transplant workload, there is no variation in graft survival and only minor variation in transplant functional outcome.