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Divya Srikumaran, Jack Campbell, Fasika Woreta, Chris Stoeger, Cathy McClory, Marie Engstrom, Patrick Johnson, Kara Johnston; Primary Graft Failure Following Keratoplasty in the United States: Current Trends. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3580.
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© ARVO (1962-2015); The Authors (2016-present)
Over the past decade, endothelial keratoplasty (EK) has become the most commonly performed corneal transplant in the United States, surpassing the numbers of penetrating keratoplasty (PK). The purpose of this study is to report the incidence of primary graft failure and early re-grafting in patients undergoing keratoplasty procedures using data from six participating eye banks.
Adverse reaction forms filled out by operating surgeons for domestically placed corneal tissue between 2013-2018 were reviewed retrospectively. Corneal donor tissue types included penetrating keratoplasty (PK), Descemet’s Stripping endothelial keratoplasty (DSEK) and Descement’s Membrane Endothelial Keratoplasty (DMEK). Primary graft failure was defined as persistent corneal edema at 8 weeks after keratoplasty. Early re-graft was defined as repeat transplantation within 8 weeks of the initial surgery. Descriptive statistics were utilized to report the cumulative incidence of primary graft failure and early re-graft according to the procedure performed.
The six participating eye banks placed a total of 82,566 grafts during the study period. Primary graft failure was reported for 513 donor grafts (0.62%) overall, with 0.73% (104/14,284) occurring after DMEK, 0.70% (264/37,603) after DSEK, and 0.47% (145/30,679) after PK. While in 2013, primary graft failure was reported more frequently for DMEK (4.5%) than DSEK (0.50%) and PK (0.55%), in 2018, the rates were almost identical (0.35% for DMEK, 0.89% for DSEK, and 0.18% for PK). DMEK had the highest cumulative incidence of early re-graft during the study periods with 0.44% of grafts compared to 0.16% for DSEK and 0.05% for PK.
Overall, PGF and early re-graft are infrequent. EK procedures have higher incidence of primary graft failure and early re-grafts compared to PK. Since 2013 the incidence of primary graft failure after DMEK has decreased significantly suggesting that surgeons and eye banks are overcoming the learning curve of the procedure.
This is a 2020 ARVO Annual Meeting abstract.
Figure 1. Incidence of primary graft failure.
Figure 2. Incidence of early re-graft.
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