Risk factors for various causes of failure in initial corneal grafts.

OBJECTIVE To determine the risk factors for specific causes of initial corneal graft failure. METHODS This study analyzed corneal graft survival rates in a longitudinal noncomparative case series of 3992 consecutive penetrating keratoplasties performed at a single large referral center. Regrafts (n = 352) were excluded from the analysis of risk factors for initial graft failure. Data were collected retrospectively from August 1, 1982, through December 31, 1986, and prospectively from January 1, 1987, through August 31, 1996. Patients were examined preoperatively, at 1, 3, 6, 9, 12, 18, and 24 months posttransplantation, and annually thereafter. Potential risk factors were evaluated individually by Kaplan-Meier survival analysis. Cox proportional hazards regression modeling was then used to investigate the impact of each independent variable, adjusted for the confounding influence of the other independent variables. RESULTS The use of topical glaucoma medications was a significant risk factor for corneal graft failure by 3 major causes: rejection, endothelial decompensation without a documented immunologic reaction, and ocular surface disease. Deep stromal vascularization was an independent risk factor for rejection failure. Diabetes mellitus, peripheral anterior synechiae, recipient race, and small trephination size were significant risk factors for endothelial failure. CONCLUSION Independent risk factors differentially impact specific causes of corneal graft failure.

[1]  H. Völker‐Dieben,et al.  Hierarchy of prognostic factors for corneal allograft survival. , 1987, Australian and New Zealand journal of ophthalmology.

[2]  Hill Jc.  The relative importance of risk factors used to define high-risk keratoplasty. , 1996 .

[3]  A. Béchetoille,et al.  Ocular surface inflammatory changes induced by topical antiglaucoma drugs: human and animal studies. , 1999, Ophthalmology.

[4]  P. Laughrea,et al.  Risk factors of corneal graft failure. , 1993, Ophthalmology.

[5]  P. Laughrea,et al.  Effect of factors unrelated to tissue matching on corneal transplant endothelial rejection. , 1989, American journal of ophthalmology.

[6]  S. Gore,et al.  INFLUENCE OF DONOR AND HISTOCOMPATIBILITY FACTORS ON CORNEAL GRAFT OUTCOME , 1994, Transplantation.

[7]  L. Cantor,et al.  Bimatoprost: a member of a new class of agents, the prostamides, for glaucoma management , 2001, Expert opinion on investigational drugs.

[8]  S. Gore,et al.  Corneal graft survival and visual outcome. A multicenter Study. Corneal Transplant Follow-up Study Collaborators. , 1994, Ophthalmology.

[9]  P. Hamard,et al.  Nonpenetrating filtering surgery , 2002, Current opinion in ophthalmology.

[10]  R. Marks,et al.  Five-year corneal graft survival. A large, single-center patient cohort. , 1993, Archives of ophthalmology.

[11]  S. Wilson,et al.  Graft failure after penetrating keratoplasty. , 1990, Survey of ophthalmology.

[12]  R. Hitchings,et al.  Long-term morphologic effects of antiglaucoma drugs on the conjunctiva and Tenon's capsule in glaucomatous patients. , 1989, Ophthalmology.

[13]  F. Price,et al.  Risk factors for corneal graft failure. , 1996, Journal of refractive surgery.

[14]  Y. Lachkar,et al.  La chirurgie filtrante non perforante : évolution du concept, réalisation, résultats , 2002 .

[15]  J. Hill.  The relative importance of risk factors used to define high-risk keratoplasty. , 1996, German journal of ophthalmology.

[16]  L. H. Long.  The world almanac and book of facts , 1966 .

[17]  R. E. Smith,et al.  Molteno implant for control of glaucoma in eyes after penetrating keratoplasty. , 1988, Ophthalmology.

[18]  J. Arentsen.  Corneal transplant allograft reaction: possible predisposing factors. , 1983, Transactions of the American Ophthalmological Society.

[19]  D. Coster,et al.  Risk Factors for Corneal Graft Failure/Comment/Comments/Response , 1996 .

[20]  M. Chipman,et al.  Changing risk for early transplant failure: data from the Ontario Corneal Recipient Registry. , 1993, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[21]  D. Musch,et al.  Risk of endothelial rejection after bilateral penetrating keratoplasty. , 1989, Ophthalmology.

[22]  R. Beck,et al.  Is donor age an important determinant of graft survival? , 2000, Cornea.

[23]  D. Hodge,et al.  Ten-year postoperative results of penetrating keratoplasty. , 1998, Ophthalmology.

[24]  J. Naor,et al.  Corneal Graft Outcome Study , 2001, Cornea.

[25]  L. Dandona,et al.  Causes of corneal graft failure in India. , 1998, Indian journal of ophthalmology.

[26]  T. Oshika,et al.  A 10-year review of penetrating keratoplasty. , 2000, Japanese journal of ophthalmology.

[27]  D. Coster,et al.  The Australian Corneal Graft Registry (ACGR) , 1994, Klinische Monatsblatter fur Augenheilkunde.

[28]  R. Marks,et al.  Graft survival in four common groups of patients undergoing penetrating keratoplasty. , 1991, Ophthalmology.

[29]  R. D. Stulting,et al.  Risk factors for corneal graft failure and rejection in the collaborative corneal transplantation studies. Collaborative Corneal Transplantation Studies Research Group. , 1994, Ophthalmology.

[30]  L. Dandona,et al.  Survival analysis and visual outcome in a large series of corneal transplants in India , 1997, The British journal of ophthalmology.

[31]  S. I. Brown,et al.  The significance of anterior synechiae after corneal transplantation. , 1972, American journal of ophthalmology.

[32]  N. Burstein.  Corneal cytotoxicity of topically applied drugs, vehicles and preservatives. , 1980, Survey of ophthalmology.

[33]  C. Baudouin.  Side effects of antiglaucomatous drugs on the ocular surface. , 1996, Current opinion in ophthalmology.

[34]  H. Gelender,et al.  The use of Molteno implant and anterior chamber tube shunt to encircling band for the treatment of glaucoma in keratoplasty patients. , 1990, Ophthalmology.

[35]  R. Barraquer,et al.  Prognostic factors in penetrating keratoplasty. , 1989, Developments in ophthalmology.