Graft survival in a previously reported cohort of patients recruited between 1967 and 1978 (10.6 years' mean follow-up) was reviewed and compared with that for a cohort recruited between 1979 and 1987 (3.8 years' mean follow-up). This allowed analysis of improved graft survival due to changes in management, introduced after critical review of the first group in 1978. The salient changes included transition from intracapsular to extracapsular cataract surgery (P = 0.001) and treatment of rejection episodes with antiviral prophylaxis. Extracapsular cataract surgery improved graft survival (P = 0.07) benefiting inflamed eyes which more frequently required concomitant surgery (P = 0.005). Survival of rejection episodes was improved by antiviral prophylaxis (P = 0.02), and the incidence of recurrent keratitis was reduced (P = 0.0005). The complete and prompt removal of loose sutures improved graft survival (P = 0.025). Long-term survival of first grafts was 70%, and management changes improved overall survival (P = 0.036) despite an increased number of eyes (P = 0.05) grafted when inflamed.