We thank Dr Fernandes and her team for their interest in our article. The purpose of our study was to evaluate and assess the role of potential postoperative risk factors in long-term graft survival, and although we agree that examining a more uniform group of indications for keratoplasty would have been an option, we decided specifically to include optical, tectonic, and therapeutic indications because this was in keeping with our findings in an earlier submission looking at preoperative and intraoperative risk factors, to enable direct correlations to be drawn. We looked at the same group of patients and for consistency, included all 3 indications to compare risk factors.

The same study population that has been described in earlier publication was used in this study, and this was stated in the manuscript in the Methods, in which we provided the mean follow-up duration, 36.8 ± 35.5 months (median, 25.07 months; range, up to 173.8 months). Please see the additional Table detailing sample size of the postoperative risk factors by year.

You may also wish to know that Kaplan-Meier survival analysis plots for all significant risk factors were generated, but specifically were not included in the article for brevity, because they already were described in the text. Plots on allograft rejection and glaucoma surgery were included to show the influence of these factors on graft survival.

The study population that was used for this analysis was taken from our previous publication, and for uniformity, 1 graft per patient was selected for analysis. The study provides a continuity of the same cohort being followed up regarding postoperative risk factors, including the preoperative risk factors. It would not be right to include the last graft in eyes with multiple grafts, as suggested by the authors, in the present study. Choosing only the last graft with multiple grafts calls for another study on selected grafts, and the interpretation will have to be taken into account in a different perspective. This will be taken as a worst-case scenario only where the purpose of the study is determining the risk factors among the worst-case scenario.

The hazard ratio (HR) for preoperative inflammation ( P = .03; HR, 1.5; 95% confidence interval, 1.03 to 2.2), perforation ( P < .01; HR, 3.4; 95% confidence interval, 1.9 to 5.7), and recurrence of primary disease ( P = .002; HR, 6.6; 95% confidence interval, 1.9 to 22.4) is provided in parenthesis beside the individual risk factors.

A significantly high HR was noted not only for pseudophakic bullous keratopathy and aphakic bullous keratopathy, but also for other indications for penetrating keratopathy, and because this was depicted in the Table, it was not elaborated on further. It implies that primary diagnosis has a strong influence on graft survival, as discussed in the article. Again, the follow-up was the same as described in our earlier publication, and the median and range has been provided additionally.

We thank you again for the kind interest.

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Jan 16, 2017 | Posted by in OPHTHALMOLOGY | Comments Off on Reply

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