A series of 160 consecutive penetrating keratoplasties was analysed for patterns of graft rejection. All surgery was performed between January 1981 and December 1987. The incidence of homograft rejection was 34% (54 grafts). The site of the initial rejection episode was analysed. It was found that when grafts with either preexisting vascularisation or loose sutures were removed from our analysis, the site of initial graft rejection was from the superior limbus in one case and from the inferior limbus in 17 cases. In eight others, there was diffuse corneal oedema at initial appearance. We feel that the increased incidence of graft rejection occurring inferiorly is significant and probably relates to the presence of some factor(s) present in the tears. By bathing the inferior corneal surface and, more importantly, the inferior graft-host interface, the risk of rejection occurring at this site is increased.
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