Five-year corneal graft survival. A large, single-center patient cohort
F. W. Price Jr, W. E. Whitson, K. S. Collins and R. G. Marks
Corneal Consultants of Indiana, Indianapolis 46260.
OBJECTIVE--To determine the survival rates and causes of secondary graft
failure in a large, consecutive series of penetrating keratoplasties.
DESIGN--All eyes undergoing penetrating keratoplasty at a single center
were evaluated for factors relating to penetrating keratoplasty
preoperatively, surgically, and postoperatively at 1, 3, 6, 9, 12, 18, and
24 months and then at yearly intervals. Since 1986, data analysis has been
prospective. SETTING--A large, private practice, tertiary center for
corneal disorders and surgery. PATIENTS--A consecutive series of 1819
penetrating keratoplasties performed from August 1982 through August 1990;
13 eyes with primary graft failure were excluded. MAIN OUTCOME
MEASURE--Graft failure and causes of failure. Follow-up ranged from 1 to 96
months, with a mean of 26.6 months. RESULTS--Pseudophakic bullous
keratopathy was the most common diagnosis necessitating keratoplasty
(38.6%). Secondary failures occurred 111 times (6.1%). The 2- and 5-year
survival rates for all grafts in the study were 95% and 91%, respectively.
While endothelial failure as a result of immunologic allograft reactions
was the most common cause of graft failure (27%), problems with the
external surface of the graft caused nearly as many failures (25%). The
risk of failure from surface-related problems was highest at 3 months after
surgery. There were significantly decreased survival rates for grafts in
eyes with regrafts (P < .0001), in eyes left aphakic at keratoplasty (P
< .0001), and in eyes with deep stromal vascularization (P < .0001).
CONCLUSION--Penetrating keratoplasty is a successful form of
transplantation, and survival rates are gradually increasing. The risk of
graft failure appears highest within the first year after transplantation.
