Ophthalmology
Volume 116, Issue 6 , Pages 1023-1028, June 2009

Recipient Risk Factors for Graft Failure in the Cornea Donor Study

Presented at: American Academy of Ophthalmology Annual Meeting, Atlanta, Georgia, November 2008.

  • Alan Sugar, MD

      Affiliations

    • W. K. Kellogg Eye Center, The University of Michigan, Ann Arbor, Michigan
    • Corresponding Author InformationCorrespondence: Alan Sugar, MD, c/o Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647
    • ,
  • Jean Paul Tanner, MPH

      Affiliations

    • Jaeb Center for Health Research, Tampa, Florida
    • ,
  • Mariya Dontchev, MPH

      Affiliations

    • Jaeb Center for Health Research, Tampa, Florida
    • ,
  • Brad Tennant, BA

      Affiliations

    • Midwest Eye Banks, Ann Arbor, Michigan, Tampa, Florida
    • ,
  • Robert L. Schultze, MD

      Affiliations

    • Cornea Consultants of Albany, Albany, New York
    • ,
  • Steven P. Dunn, MD

      Affiliations

    • Michigan Cornea Consultants, PC, Southfield, Michigan
    • ,
  • Thomas D. Lindquist, MD, PhD

      Affiliations

    • Virginia Mason Medical Center, Seattle, Washington
    • ,
  • Robin L. Gal, MSPH

      Affiliations

    • Jaeb Center for Health Research, Tampa, Florida
    • ,
  • Roy W. Beck, MD, PhD

      Affiliations

    • Jaeb Center for Health Research, Tampa, Florida
    • ,
  • Craig Kollman, PhD

      Affiliations

    • Jaeb Center for Health Research, Tampa, Florida
    • ,
  • Mark J. Mannis, MD

      Affiliations

    • University of California Davis, Sacramento, California
    • ,
  • Edward J. Holland, MD

      Affiliations

    • Cincinnati Eye Institute, Cincinnati, Ohio
    • ,
  • Cornea Donor Study Investigator Group

Received 3 September 2008; received in revised form 20 November 2008; accepted 18 December 2008. published online 23 April 2009.

Available online: April 23, 2009.

Purpose

To identify recipient factors that may be related to risk of corneal graft failure.

Design

Multicenter, prospective, double-masked, controlled clinical trial.

Participants

One thousand ninety subjects undergoing corneal transplantation for a moderate-risk condition (principally Fuchs' dystrophy or pseudophakic corneal edema).

Methods

Donor corneas were assigned using a random approach without respect to recipient factors, and surgeons were masked to information about the donor cornea, including donor age. Surgery and postoperative care were performed according to the surgeons' usual routines, and subjects were followed up for 5 years. Baseline factors were evaluated for their association with graft failure.

Main Outcome Measures

Graft failure, defined as a regraft or a cloudy cornea that was sufficiently opaque to compromise vision for a minimum of 3 consecutive months.

Results

Preoperative diagnosis of pseudophakic or aphakic corneal edema increased graft failure risk approximately 4-fold compared with Fuchs' dystrophy (27% vs. 7%). Prior glaucoma surgery with preoperative glaucoma medication use substantially increased the graft failure rate. Factors not strongly associated with graft failure included age, gender, diabetes, smoking, and graft size.

Conclusions

The risk of graft failure is significantly increased in eyes with pseudophakic or aphakic corneal edema compared with Fuchs' dystrophy, independent of lens status, and in eyes with a history of glaucoma.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

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 Manuscript no. 2008-1059.

 A list of the members of the Cornea Donor Study Investigator Group is available at http://aaojournal.org (Ophthalmology 2008;115:620-6).

 Financial Disclosure(s): The author(s) have made the following disclosure(s): Roy W. Beck received financial support from Bausch & Lomb, Inc., Katena Products, Inc., ViroMed Laboratories, Inc., Konan Medical Corp.

 Supported by the National Eye Institute, Bethesda, Maryland (cooperative agreement nos.: EY12728 and EY12358); Additional support provided by Eye Bank Association of America, Washington, DC; Bausch & Lomb, Inc., Rochester, New York; Tissue Banks International, Baltimore, Maryland; Vision Share, Inc., Apex, North Carolina; San Diego Eye Bank, San Diego, California; The Cornea Society, Fairfax, Virginia; Katena Products, Inc., Denville, New Jersey; ViroMed Laboratories, Inc., Minnetonka, Minnesota; Midwest Eye-Banks (Michigan Eye-Bank, Illinois Eye-Bank), Ann Arbor, Michigan; Konan Medical Corp., Torrance, California; Eye Bank for Sight Restoration, New York, New York; SightLife, Seattle, Washington; Sight Society of Northeastern New York (Lions Eye Bank of Albany), Albany, New York; and the Lions Eye Bank of Oregon, Portland, Oregon.

PII: S0161-6420(08)01350-X

doi:10.1016/j.ophtha.2008.12.050

Ophthalmology
Volume 116, Issue 6 , Pages 1023-1028, June 2009

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