Long-term ocular complications after kidney transplantation.

To assess long-term ocular complications and identify factors affecting these complications in pre-emptive and dialysis patients who have undergone kidney transplantation. We included 548 patients who had a complete ophthalmologic examination at least one year after kidney transplantation. The patients were divided into two groups: those who received dialysis before kidney transplantation (group 1) and those who did not (group 2). We recorded the presence of diabetes mellitus (DM) and hypertension (HT), which could contribute to concomitant retinopathy. Data collected included best corrected visual acuity (BCVA), refractive error (measured with KR-8900; Topcon, Tokyo, Japan), intraocular pressure (IOP, measured with Full Auto Tonometer TX-F; Topcon), slit-lamp examination of the anterior segment, and dilated fundus examination for both eyes. Refractive error, lens opacity, pinguecula, pterygium, arcus lipoides, corneal calcification, macular drusen, central serous chorioretinopathy (CSC), hypertensive retinopathy, and diabetic retinopathy were all recorded. All patients received a maintenance immunosuppressive protocol consisting of combinations of steroids, calcineurin inhibitors (CNI), mycophenolate mofetil, and mammalian target of rapamycin (mTOR) inhibitors. Our study included 257 recipients in group 1 and 291 recipients in group 2. In group 1, 37 recipients (12.7%) required myopic correction, while 35 recipients (13.6%) in group 2 needed similar correction. Additionally, 47 recipients (16.2%) in group 1 required hyperopic correction, compared to 35 recipients (13.6%) in group 2. There was no statistically significant difference between the two groups (p > 0.05).Regarding anterior segment findings, 56 recipients (21.8%) in group 1 and 35 recipients (12%) in group 2 were diagnosed with dry eye, with a statistically significant higher incidence in group 1 (p = 0.003). The rates of arcus lipoides, pinguecula, pterygium, cataract, and glaucoma were similar in both groups (p > 0.05). For posterior segment findings, diabetic retinopathy was observed in 65 patients (25.3%) in group 1 and 47 patients (16.2%) in group 2, showing a statistically significant higher incidence in group 1 (p = 0.011). Other posterior segment conditions, including macular drusen, hypertensive retinopathy, and central serous chorioretinopathy (CSC), were present at similar rates in both groups, with no statistically significant differences found (p > 0.05). We identified dry eyes, cataracts, and retinopathy as the most common ocular complications, with dry eyes and diabetic retinopathy being significantly more prevalent in group 1. Our study indicates that the risk of developing and progressing diabetic retinopathy is higher in patients who received dialysis before transplantation compared to those who underwent pre-emptive transplantation. This finding underscores the importance of preoperative factors in the development of ocular complications after successful kidney transplantation, independent of postoperative factors.