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Endothelial Graft Failure After Contralateral Autologous Corneal Transplantation

Martinez, Jaime D. MD; Galor, Anat MD, MSPH; Perez, Victor L. MD; Karp, Carol L. MD; Yoo, Sonia H. MD; Alfonso, Eduardo C. MD

doi: 10.1097/ICO.0b013e31826dff17
Clinical Science

Purpose: To report on outcomes after contralateral autologous penetrating keratoplasty (APK).

Design: Case series.

Patient Population: Five patients who received a contralateral APK and a simultaneous allogeneic penetrating keratoplasty in the donor eye at the Bascom Palmer Eye Institute and the Miami Veterans Affairs Hospital.

Results: The median patient age at the time of surgery in our 5 patients was 67 years (range, 58–88 years); 4 patients were male and 1 female, and 1 patient was white and 4 were black. The surgery was uneventful in all cases, and no operative or immediate postoperative complications occurred in either eye. Follow-up time ranged from 18 to 54 months (mean, 35 months; median, 34 months). During this time, 4 of the autologous grafts failed because of endothelial attenuation. Identified risk factors for failure in the autologous eyes included the presence of a glaucoma tube (5/5), previous graft failure (4/5), and anterior synechiae (2/5).

Conclusions: This study is the first to describe graft failure because of slow endothelial attenuation after APK. This study underscores the importance of nonimmunologic factors in endothelial cell loss after corneal transplant surgery and highlights the need for further research to understand and modulate endothelial loss.

*Surgical Division, Miami Veterans Administration Medical Center, Miami, FL

Cornea and External Diseases division, Bascom Palmer Eye Institute, University of Miami, Miami, FL.

Reprints: Anat Galor, Surgical Division, Miami VAMC, 1201 NW 16th St, Miami, FL 33125 (e-mail:

Supported by NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant, Department of Defense (Grant #W81XWH-09-1-0675) (institutional grants), VA Career Development Award (A.G.), The Ronald and Alicia Lepke Grant (C.L.K.), and The Lee and Claire Hager Grant (C.L.K.).

The authors have no funding or conflicts of interest to disclose.

Received May 6, 2012

Accepted August 6, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.