5-YEAR CORNEAL GRAFT-SURVIVAL - A LARGE, SINGLE-CENTER PATIENT COHORT

Objective.-To determine the survival rates and causes of secondary gra ft failure in a large, consecutive series of penetrating keratoplastie s. Design.-All eyes undergoing penetrating keratoplasty at a single ce nter were evaluated for factors relating to penetrating keratoplasty p reoperatively, surgically, and postoperatively at 1, 3,6, 9,12,18, and 24 months and then at yearly intervals. Since 1986, data analysis has been prospective. Setting.-A large, private practice, tertiary center for corneal disorders and surgery. Patients.-A consecutive series of 1819 penetrating keratoplasties performed from August 1982 through Aug ust 1990; 13 eyes with primary graft failure were excluded. Main Outco me Measure.-Graft failure and causes of failure. Follow-up ranged from 1 to 96 months, with a mean of 26.6 months. Results.-Pseudophakic bul lous keratopathy was the most common diagnosis necessitating keratopla sty (38.6%). Secondary failures occurred 111 times (6.1%). The 2- and 5-year survival rates for all grafts in the study were 95% and 91%, re spectively. While endothelial failure as a result of immunologic allog raft reactions was the most common cause of graft failure (27%), probl ems with the external surface of the graft caused nearly as many failu res (25%). The risk of failure from surface-related problems was highe st at 3 months after surgery. There were significantly decreased survi val rates for grafts in eyes with regrafts (P<.0001), in eyes left aph akic at keratoplasty (P<.0001), and in eyes with deep stromal vascular ization (P<.0001). Conclusion.-Penetrating keratoplasty is a successfu l form of transplantation, and survival rates are gradually increasing . The risk of graft failure appears highest within the first year afte r transplantation.