Corneal Transplant Survival after Onset of Severe Endothelial Rejection
Received 29 June 2006; received in revised form 9 December 2006; accepted 11 December 2006. published online 16 March 2007.
Purpose
To evaluate corneal graft survival after onset of severe endothelial rejection after penetrating keratoplasty (PK).
Design
Retrospective case series.
Participants
One hundred fifty-six patients (161 PKs) treated at a single center.
Methods
Retrospective review of the medical records of every case of severe endothelial rejection admitted to the King Khaled Eye Specialist Hospital (KKESH) between January 1, 1998 and December 31, 2002. Patients for whom PK had been performed at KKESH between June 1, 1983 and December 31, 2002 and in whom at least 3 months of follow-up was available were included in the statistical analysis.
Main Outcome Measure
Graft survival.
Results
One hundred fifty-seven PKs (152 patients) met the inclusion criteria and were included in the statistical analysis. Four PKs (4 patients) were excluded from the statistical analysis due to inadequate follow-up. The rejection episode was reversed during the first 3 months in 90 grafts (57.3%). By Kaplan–Meier analysis, graft survivals were 42.6% at 1 year and 36.1% at 3 years. The surgical indication for PK significantly correlated with likelihood of reversibility (P<0.001) and long-term graft survival (P<0.001). Risk factors associated with an increased risk of postrejection graft failure included increasing donor age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.04–1.24; P = 0.004), increasing patient age (OR, 1.23; 95% CI, 1.11–1.35; P<0.001), and history of rejection episodes (P = 0.002).
Conclusion
Endothelial rejection is a serious complication of PK, with a high risk of graft failure.
Available online: March 16, 2007.
1Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia.
2Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa.
3Department of Biostatistics, College of Medicine, University of Iowa, Iowa City, Iowa.
Correspondence to Michael D. Wagoner, MD, Medical Director, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh 11462, Saudi Arabia.
Manuscript no. 2006-712.
The authors have no conflicts of interest with or proprietary interest in any of the topics presented in the article.
ABSTRACT