PRIMARY GRAFT FAILURE - A CASE-CONTROL INVESTIGATION OF A PURPORTED CLUSTER

Primary graft failure is a rare but major complication of penetrating keratoplasty. An apparent clustering of four cases during a 1-month pe riod led to a review of all 778 keratoplasties performed by nine surge ons at Massachusetts Eye and Ear Infirmary from July 1, 1986 to June 3 0, 1988. The objectives of this study were (a) to investigate the poss ibility that cases of primary graft failure occurred in clusters withi n their physical environment of space, time, and personnel and (b) to determine the frequency of and evaluate possible risk factors for prim ary graft failure. Twenty-one cases of primary graft failure were foun d, resulting in an incidence rate of 2.7% during this period. A 13.3% incidence of primary graft failure was found in donor mates, suggestin g improper tissue preparation. The charts and eye bank records of the 21 cases and 84 age-matched controls, randomly selected from the group of all keratoplasties, were reviewed for donor-, recipient-, surgeon- , and surgery-related characteristics. Improper tissue preparation was not associated with primary graft failure. An individual surgeon was the most significant risk factor [odds ratio = 6 (95% CI: 2.1-17.0)].