April 2010
Volume 51, Issue 13
ARVO Annual Meeting Abstract  |   April 2010
Corneal Neovascularization as a Risk Factor for Graft Failure and Rejection Following Keratoplasty: An Evidence-Based Meta-Analysis
Author Affiliations & Notes
  • B. O. Bachmann
    Ophthalmology, Friedrich Alexander University, Erlangen, Germany
  • R. S. Taylor
    Ophthalmology, Peninsula Medical School of Medicine & Dentistry, Universities of Exeter and Plymouth, United Kingdom
  • C. Cursiefen
    Ophthalmology, Friedrich Alexander University, Erlangen, Germany
  • Footnotes
    Commercial Relationships  B.O. Bachmann, None; R.S. Taylor, GeneSignal, C; C. Cursiefen, GeneSignal, C.
  • Footnotes
    Support  Interdisciplinary Center for Clinical Research (IZKF) Erlangen (A9); German Research Foundation (DFG; SFB 643: B10), Bonn, Germany; GeneSignal, Evry (Paris), France
Investigative Ophthalmology & Visual Science April 2010, Vol.51, 782. doi:
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    • Get Citation

      B. O. Bachmann, R. S. Taylor, C. Cursiefen; Corneal Neovascularization as a Risk Factor for Graft Failure and Rejection Following Keratoplasty: An Evidence-Based Meta-Analysis. Invest. Ophthalmol. Vis. Sci. 2010;51(13):782.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : Pre-operative corneal neovascularization (CNV) is thought to be associated with an increased rate of corneal graft failure and potentially also graft rejection. New therapeutic options which offer differential influence on the ingrowths or regression of either corneal blood or lymphatic vessels force us to re-evaluate the data which is known about the role of CNV in keratoplasty.

Methods: : Electronic databases and corneal registries were searched (up to September 2008). Results were reported both descriptively for each study and using random effects meta-analysis. Potential moderating factors for the association between vascularization and graft failure and rejection were examined using meta-regression analysis.

Results: : Nineteen studies reporting on a total of 24,944 grafts undergoing keratoplasty were included. An increase in the risk of graft failure and rejection in the presence of pathologic corneal neovascularization was seen in studies with a pooled risk ratio of 1.32 (95% confidence interval (CI): 1.15 to 1.49) for graft failure and 2.07 (95% CI: 0.98 to 3.15) for graft rejection. There was evidence of incremental increase of risk for graft failure and rejection as more corneal quadrants were affected by neovascularization. The two factors predictive of increased risk of neovascularization and graft failure were increased recipient age (P = 0.003) and male sex (P = 0.046).

Conclusions: : Graft failure and rejection risk increase the greater the number of corneal quadrants affected by neovascularization before keratoplasty. These data support the study of novel topical antiangiogenic therapies at the cornea to precondition such a cornea for future corneal grafting.

Keywords: neovascularization • immunomodulation/immunoregulation • transplantation 

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