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M. Hillarby, I. Rahman, D. Haider, M.-C. Huang, F. Carley, A. Brahma, A. B. Tullo; Aetiology and Incidence of Rejection in Penetrating Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4674.
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Penetrating keratoplasty (PK) is the commonest and most successful form of transplantation. However, 20% will experience episodes of rejection within 10 years. In fact, immune mediated graft rejection remains the commonest cause of graft failure and is a major reason for regrafting. The aim of this study was to ascertain episodes, contributing factors and outcomes relating to corneal graft rejection
Retrospective case note review of patients who have undergone penetrating keratoplasty at the Manchester Royal Eye Hospital, during a 3 year period from January 1st 2000 to 31st December 2003.
Of 290 patients undergoing PK during the study period, 229 eyes of 207 patients’ case notes were available for review. Forty-four episodes of graft rejection occurred in 37 patients (19%), comprising 14 females and 23 males. Average preoperative BCVA of 200/600 improved to 20/100 postoperatively, although 4 patients required regrafting. Preoperative indications for PK included Keratoconus (14), regrafts (10), postoperative corneal compromise (5), dystrophies (5), microbial keratitis (4), ulcerative keratitis (3), others (2). Three patients rejected in both eyes and 4 patients had 2 episodes in the same eye. Average follow-up of the group was 59 months. However, mean time to rejection was 14.6 months. 18 (49%) of the 37 patients resulted in failed grafts which accounted for 50% of total graft failures in the 229 patients. Postoperatively 3 patients suffered an episode of microbial keratitis, 4 suffered postoperative glaucoma, 6 suffered corneal epithelial defects several weeks-months post PK.
Corneal graft rejection is a common and potentially devastating complication of corneal transplantation. A large proportion of grafts appear to reject within the first 12 months
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