Risk factors of corneal graft failure

Ophthalmology. 1993 Nov;100(11):1728-35. doi: 10.1016/s0161-6420(93)31409-0.


Purpose: To measure the association between potential risk factors and corneal graft failure. Two failure outcomes are compared: those with and those without a prior immune allograft reaction.

Methods: Based on a single-center observational study design, 539 adult recipients of a corneal graft were followed for a median time of 30 months. Survival analysis was carried out.

Results: Eighty-two graft failures were recorded. Of 82 failures, 53 (65%) were not preceded by an immune allograft reaction. Presence of blood vessels in the recipient cornea was associated with a twofold increase in risk for both failure outcomes. Three factors increased the risk of failure without an immune reaction: prior glaucoma or uveitis (adjusted relative risk estimate = 3.1), vitreous surgery with the graft (adjusted relative risk estimate = 2.0), and a repeat graft in the study eye (adjusted relative risk estimate = 2.0). Conversely, large graft wound size (adjusted relative risk estimate = 2.0). Conversely, large graft wound size (adjusted relative risk estimate = 2.9) and human leukocyte antigen (HLA)-A, -B incompatibility (adjusted relative risk estimate = 2.2) were associated with failures that followed an immune reaction.

Conclusion: In this study, the authors support the clinical impression that corneal graft failures with and without a prior immune reaction are distinct phenomena. Enhanced surveillance in recipients with glaucoma and early intensive treatment of allograft reactions are recommended to improve the outcome of corneal grafts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cataract Extraction
  • Corneal Transplantation*
  • Female
  • Follow-Up Studies
  • Glaucoma / complications
  • Graft Rejection / epidemiology
  • Graft Rejection / etiology*
  • Humans
  • Male
  • Middle Aged
  • Risk Factors
  • Transplantation, Homologous
  • Uveitis / complications
  • Vitrectomy / adverse effects