This retrospective study found that while allograft rejection is frequent during the two years after corneal graft for keratoconus, the 20-year probabilities of graft failure and keratoconus recurrence are low.
The authors estimated the long-term likelihood of graft survival, allograft rejection, and recurrence, as well as vision-related quality of life, in 184 subjects (219 eyes) who underwent corneal transplantation for keratoconus at a single center between 1980 and 1986. Follow-up was available up to 27 years after surgery (median, 10 years).
Rejection occurred in 98 of 219 grafts. Most rejections occurred during the first two years (probability, 41 percent). Keratoconus recurrence was noted in six grafts nine to 20 years after surgery, with a 20-year probability of 10 percent. Eighteen grafts failed, with a 20-year probability of 12 percent.
Larger host trephine size, male donor sex, and nonwhite donor race were associated with increased risk of graft rejection. Worse astigmatism and nonwhite recipient race were associated with increased risk of graft failure.
The mean composite score of the 28 subjects who completed the 25-item National Eye Institute Visual Function Questionnaire at an average of 23 years after surgery was 84.5.
The authors conclude that these results are encouraging for people with keratoconus who are considering undergoing transplantation. While allograft rejection is a common occurrence during the first few years after the procedure, it diminishes in likelihood subsequently.