PURPOSE: To determine postoperative risk factors that influence long-term corneal graft survival. DESIGN: Prospective cohort study. METHODS: Nine-hundred one consecutive penetrating keratoplasty procedures for optical, therapeutic, or tectonic indications from the Singapore Corneal Transplant Study. Univariate and multivariate analysis was performed for postoperative risk factors; Cox proportional hazards regression with a time-dependent covariate was used for preoperative, intraoperative, donor, and postoperative risk factors in a combined model. RESULTS: Raised intraocular pressure (20.7%) was the most common complication, followed by rejection (18.2%), whereas glaucoma surgery (7.9%) and repeat grafting (7.3%) were the most common procedures after penetrating keratoplasty. The primary graft failure rate was 1.4%, and late failure was seen in 9.4% of eyes. In the combined regression model, rejection (hazard ratio [HR], 3.4; P = .00), microbial keratitis (HR, 3.6; P = .00), endophthalmitis (HR, 7.7; P = .00), primary disease recurrence (HR, 73.9; P = .00), wound dehiscence (HR, 2.8; P = .02), lid surgery (HR, 2.3; P = .02), glaucoma surgery (HR, 2.46; P = .02), and repeat grafting (HR, 3.2; P = .00) were the significant postoperative failure predictors; the significant preoperative and intraoperative factors identified were female gender, graft size of less than 7 mm and more than 9 mm, primary diagnosis, preoperative inflammation, and preexisting perforation. CONCLUSIONS: Postoperative complications and operative procedures after grafting have an adverse effect on graft survival.
PURPOSE: To determine postoperative risk factors that influence long-term corneal graft survival. DESIGN: Prospective cohort study. METHODS: Nine-hundred one consecutive penetrating keratoplasty procedures for optical, therapeutic, or tectonic indications from the Singapore Corneal Transplant Study. Univariate and multivariate analysis was performed for postoperative risk factors; Cox proportional hazards regression with a time-dependent covariate was used for preoperative, intraoperative, donor, and postoperative risk factors in a combined model. RESULTS: Raised intraocular pressure (20.7%) was the most common complication, followed by rejection (18.2%), whereas glaucoma surgery (7.9%) and repeat grafting (7.3%) were the most common procedures after penetrating keratoplasty. The primary graft failure rate was 1.4%, and late failure was seen in 9.4% of eyes. In the combined regression model, rejection (hazard ratio [HR], 3.4; P = .00), microbial keratitis (HR, 3.6; P = .00), endophthalmitis (HR, 7.7; P = .00), primary disease recurrence (HR, 73.9; P = .00), wound dehiscence (HR, 2.8; P = .02), lid surgery (HR, 2.3; P = .02), glaucoma surgery (HR, 2.46; P = .02), and repeat grafting (HR, 3.2; P = .00) were the significant postoperative failure predictors; the significant preoperative and intraoperative factors identified were female gender, graft size of less than 7 mm and more than 9 mm, primary diagnosis, preoperative inflammation, and preexisting perforation. CONCLUSIONS: Postoperative complications and operative procedures after grafting have an adverse effect on graft survival.
Authors: Steven P Dunn; Robin L Gal; Craig Kollman; Dan Raghinaru; Mariya Dontchev; Christopher L Blanton; Edward J Holland; Jonathan H Lass; Kenneth R Kenyon; Mark J Mannis; Shahzad I Mian; Christopher J Rapuano; Walter J Stark; Roy W Beck Journal: Cornea Date: 2014-10 Impact factor: 2.651
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Authors: R Doyle Stulting; Alan Sugar; Roy Beck; Michael Belin; Mariya Dontchev; Robert S Feder; Robin L Gal; Edward J Holland; Craig Kollman; Mark J Mannis; Francis Price; Walter Stark; David D Verdier Journal: Cornea Date: 2012-10 Impact factor: 2.651
Authors: Alan Sugar; Robin L Gal; Craig Kollman; Dan Raghinaru; Mariya Dontchev; Christopher R Croasdale; Robert S Feder; Edward J Holland; Jonathan H Lass; Jonathan I Macy; Mark J Mannis; Patricia W Smith; Sarkis H Soukiasian; Roy W Beck Journal: JAMA Ophthalmol Date: 2015-03 Impact factor: 7.389