PK graft failure common after graft rejection

This analysis of graft rejection 10 years after penetrating keratoplasty (PK) in the Cornea Donor Study found that patients who experienced a definite rejection event frequently developed graft failure, with the combination of previous use of glaucoma medications and glaucoma filtering surgery a significant risk factor related to rejection.

Of the 1,090 participants in the study, 12% had at least one definite rejection episode and 16% had a probable rejection episode at 10 years.

The only significant risk factor for graft rejection was a history of glaucoma, particularly in patients who had prior glaucoma surgery and were using glaucoma medications at the time of corneal transplantation. Of the corneal transplants that survived at 5 years, the rate of graft failure at 10 years was 12% in eyes without a rejection episode versus 22% in eyes with a definite rejection episode. Slightly less than one-third of patients experiencing a definite rejection reaction remained clear at the end of the study period.

Patients with pseudophakic or aphakic corneal edema (PACE) had worse results than those with Fuchs’ dystrophy (22% cleared versus 37%). The authors were unable to determine an explanation for this pattern, although they say the higher incidence of glaucoma in patients with PACE is very likely a contributing factor.

This study’s findings demonstrate the importance of preventing corneal transplant rejection for long-term graft survival. Further studies on the use of steroids or other anti-inflammatory agents in the early and long-term management of corneal grafts will be important.