MANAGEMENT OF PRIMARY CORNEAL GRAFT FAILURE

Purpose. We report two patients with primary graft failure (PGF) from a mutual donor. The surgery in each case was done by a different surge on experienced in penetrating keratoplasty (PK). The cases were manage d differently in the postoperative period with good visual results in both cases. We discuss the various management options available when c onfronted with apparent PGF in the early postoperative period. Methods . Both patients had excessive graft edema and haze in the immediate po stoperative period. Case 1 received a repeat graft after 4 weeks becau se there was no improvement in graft clarity despite intensive topical steroids. In case 2, repeat surgery was deferred with ultimate gradua l improvement in the clarity of the graft over a period of 6 months. R esults. Both patients obtained clear grafts with a visual acuity of 20 /30 at 15 months after surgery. Conclusion. Primary graft failure is a rare complication of PK. Repeat PK is the most definitive therapeutic alternative, although some grafts may clear without any additional su rgery. We suggest all cases of PGF be observed for greater than or equ al to 3-4 weeks for signs of graft clearing before proceeding with a r epeated PK.