Purchase this article with an account.
S. Roters, G. Welsandt, M. Hellmich, P. Szurman, Gü. K. Krieglstein; Long-Term Outcome of Penetrating Keratoplasties Performed 1990 - 1999. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4688.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
To report graft survival results for penetrating keratoplasty (PK) performed 1990-1999. Secondary outcome measures included incidence of immune reaction, rates of graft failure and rates of glaucoma.
Retrospective, consecutive, no comparative case series.
All patients who underwent PK at the Center of Ophthalmology Cologne, Germany in the years 1990 - 1999 with a minimum follow-up of one year. At baseline, age, gender, previous surgery, history of glaucoma, vascularisation of host cornea, donor graft size, graft characteristics (matched or random, kind of storage) for each eye were recorded. The surgical outcome was evaluated concerning clearness of transplant, incidence of immune reaction, intra- and postsurgical complications. Kaplan-Meier survival analysis was performed to estimate the long-term probability of graft failure.
Among the 683 corneal transplants (RE 351, LE 332) of 531 patients who met entry criteria, there was a mean age at transplant of 55.7 years. Combined surgery (e.g. iridectomy, cataract surgery, vitrectomy) was performed in 512 eyes. With a mean follow-up of 2.82 years (range 1.01-9.12 years), 142 eyes (21%) experienced graft failure. Immune reaction occurred in 96 eyes (14%) but 56 grafts became clear with therapy. Fiftysix eyes (7%) developed secondary glaucoma. 509 secondary surgery in 321 eyes were performed. Kaplan-Meier analysis estimated a statistical significant worse graft survival rate in case of repeated keratoplasty (n=148, p=<0.005) (but not in case of fellow eye transplantation, n=143, p=0.69), in high risk keratoplasty (n=156, p=<0.005), in case of previous surgery (n=260, p=<0.005), combined surgery with silicone oil (n=103, p=<0.005), matched graft transplantation (n=59, p=0.006) and transplantation after storage in organ culture (n=247, p=0.006).
Corneal transplant opacification were documented in 198 grafts (29%), by immune response in half the grafts. An irreversible failure occurred in 142 (21%) grafts whereof 40 grafts suffer an immune reaction. The rate of secondary glaucoma was 7%. Beside the established risk factors for transplant immune reaction and graft failure the number of secondary surgery in half the eyes should be incorporated into preoperative counseling.
This PDF is available to Subscribers Only