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Corneal Transplant Rejection Rate and Severity After Endothelial Keratoplasty

Allan, Bruce DS MD*; Terry, Mark A MD; Price, Francis W Jr MD; Price, Marianne O PhD§; Griffin, Neil B MD; Claesson, Margareta MD

doi: 10.1097/ICO.0b013e31812f66e5
Clinical Science

Purpose: To examine the corneal transplant rejection rate and the rate of graft failure subsequent to rejection in the first 2 years after endothelial keratoplasty (EK) and to compare this to background data for similar cases of penetrating keratoplasty (PK).

Methods: Anonymized data from consecutive cases of EK [deep lamellar (DLEK) or Descemet stripping (DSEK)] for Fuchs corneal endothelial dystrophy or pseudophakic bullous keratopathy operated on before August 2004 were collected in 4 participating centers. The number and timing of rejection episodes and cases of subsequent graft failure were recorded, together with the time to cessation of topical steroid medication. Two-year postoperative findings were compared with background data for similar patients undergoing PK recorded in the Swedish Corneal Transplant Registry.

Results: Rejection episodes were less frequent after EK than PK (P = 0.035). Fifteen (7.5%) of 199 EK cases had a rejection episode in the first 2 years after surgery versus 92 (13%) of 708 PK cases. Graft failure after rejection in EK may have been less frequent than in PK (P = 0.063), with only 1 (6.7%) case of rejection after EK versus 26 (28.3%) cases of rejection after PK proceeding to graft failure. A strong trend toward continued use of low-dose topical steroid medication was observed in the EK group. Eighty percent of EK patients were still taking topical steroid medication 2 years after surgery, whereas topical steroid medication had been ceased within a year of surgery in almost all PK patients in the comparator group.

Conclusions: Corneal transplant rejection is less frequent and may be less severe after EK than after PK. It is not yet clear whether these apparent differences are simply a product of relatively prolonged postoperative topical steroid cover in EK patients.

From the *Moorfields Eye Hospital, London, UK; the †Devers Eye Institute, Portland, OR; the ‡Price Vision Group, Indianapolis, IN; the §Cornea Research Foundation of America, Indianapolis, IN; the ¶Carolina Eye Associates, Pinehurst, NC; and the Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden.

Received for publication December 6, 2006; revision received May 9, 2007; accepted May 11, 2007.

Reprints: Bruce Allan, Moorfields Eye Hospital, City Road, London EC1V 2PD, UK (e-mail

© 2007 Lippincott Williams & Wilkins, Inc.