Opinions on risk factors and management of corneal graft rejection in the United Kingdom

Purpose: To determine the opinions regarding risk factors and practice preferences for corneal graft rejection by members of the Bowman Club (UK) and to compare them with those of members of the Castroviejo Society (USA). Methods: A questionnaire was sent in 1999 to members of the Bowman Club (UK), who were responsible for two thirds of all corneal grafts undertaken annually. The survey included 8 questions identical to those given to members of the Castroviejo Society (USA) in a survey carried out in 1989. Results: Thirty-six Out of 40 surgeons replied. Factors considered by respondents to be high risk for corneal graft rejection were previous corneal graft rejection in the operated eye (97 %), significant corneal vessels (97 %), and previous herpetic eye disease (94 %). The preferred routine preoperative treatment in "high-risk" patients included no treatment (47 %), topical corticosteroids (33 %), and oral prednisolone (22 %). In postoperative "high-risk" patients, 100 % of surgeons used topical and 42 % used oral corticosteroids. Immune suppression agents were used by 44 % of respondents, the majority (92 %) using cyclosporine A. In previous herpes simplex patients, 47 % of surgeons used oral and 14 % used topical antivirals preoperatively, whereas 75 % used oral and 47 % used topical postoperatively. Conclusion: This study documents the perceived risk factors and management of corneal graft rejection by corneal surgons in the UK. It showed wide variation in practice preferences, allowing individual surgeons a comparison with peer practice. It highlights the need for greater use of postoperative antiviral prophylaxis in the presence of previous herpetic corneal pathology.