Photo Credit: Zarina Lukash
The following is a summary of “Influential Factors and Outcome of High-Risk Keratoplasty in a Tertiary Referral Corneal Center: A Retrospective Study,” published in the February 2025 issue of Clinical Ophthalmology by Aschauer et al.
Researchers conducted a retrospective study to assess the outcomes of high-risk (HR) keratoplasty (KP) and identify risk factors for graft failure.
They examined data from adults who underwent HR penetrating KP between 2014 and 2022 and HR criteria included a history of repeat KP, stromal neovascularization in at least 2 quadrants, and significant inflammation or manifest perforation at the time of surgery. The primary outcome was graft failure within the first postoperative year. Donor endothelial cell count, donor age, stromal neovascularization, and presence of manifest perforation or acute inflammation during surgery were evaluated as independent variables using univariate and multivariable logistic regression.
The results showed that graft survival at 1 year was 56.2% (CI: 45.7, 66.4) after the first KP, 68.3% (CI: 59.3, 76.4) after the second, and 70.2% (CI: 56.6, 81.6) after the third. Perforation or acute inflammation at baseline was a significant independent risk factor for graft failure. Among 375 KPs performed in 257 individuals, graft failure occurred in 190 cases (51%). The median time (95% CI) to graft failure was 559 days (392, 994) for the first KP, 1,052 days (833, 1375) for the second, and 1,089 days (689, inf) for the third. Immune rejection was the most frequent cause (n=55, 29%), while in 66 cases (35%), the cause remained undefined. The median time (95% CI) until neovascularization (re-)formation was 739 days (550, inf) after the first KP and 1,566 days (1055, inf) after the second.
Investigators concluded the acute inflammation or perforation during surgery enhanced the risk of graft failure in patients with HR KP, confirming reduced survival rate.
