Long Term Results of Corneal Grafting in Keratoconus

Abstract

Fifty-four corneal grafts in 45 keratoconus patients have been followed for 3 to 12 years (average 5.8 years). The corneal clarity, visual acuity, incidence of immune rejections, relation to HLA compatibility, corneal thickness and endothelial cell density are reported. At the follow-up 98% (53 out of 54) of the grafts were clear. Visual acuity was greater than or equal to 0.67 in 72% of the cases. Suboptimal vision was due to cataract or large astigmatism. Rejection had occurred in 5 cases (10%). The graft thickness was found to decrease steadily, reaching subnormal values about 1/2 year after the operation. Six years after grafting, however, the thickness did not differ from that of normal corneas. The endothelial cell density in uncomplicated cases ranged from 450 to 3000 cells/mm2, decreasing with length of post-operative period. The HLA compatibility could not be shown to influence the endothelial cell density.

Long Term Results of Corneal Grafting in Fuchs‘ Endothelial Dystrophy

“…The cause of graft failure deserves special consideration: only 3 cases of permanent oedema developed due to rejection episodes, which were detected in a total of 5 cases (15%). This frequency is comparable to the incidence of graft rejections in keratoconus (Ehlers & Olsen 1983) and in other series reported (Sautter et a]. 1972;Abbott & Forster 1979).…”

“…A similar course was found in keratoconus grafts (Ehlers & Olsen 1983). This transient thinning might be due to a small loss of stromal tissue which has been damaged during the surgery.…”

“…2). The latest thickness reading (referring to a mean value of 65 months after the operation) was found to be within the normal range (cf Ehlers & Olsen 1983). An endothelial cell count was available in 15 cases ( Table 4).…”

Long-term Outcomes of Penetrating Keratoplasty for Keratoconus With Resolved Corneal Hydrops

“…Although the reported incidence of endothelial rejection episodes after PK in keratoconus varies widely from 3.6% to 31%, allograft survival at 5 to 12 years has been consistently reported to be greater than 90%. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Occurrence of endothelial rejection episodes in our series (6.8%, 102 eyes; mean follow-up, 5.5 years) was similar to that noted by Lim et al 5 follow up, 2 years) noted a much higher rejection episode rate of 21% and 31%, respectively. Whether the proportion of cases with hydrops or ocular allergy was higher in the latter 2 studies is not known.…”

“…2,3 However, poor vision because of central corneal scarring or contact lens intolerance necessitates a penetrating keratoplasty (PK) in 20% to 59% of patients. [2][3][4] Among the numerous studies that have reported the long-term outcomes of PK in keratoconus, [5][6][7][8][9][10][11][12][13][14][15][16][17][18] only two previous studies have explored the association between corneal hydrops and allograft rejection/survival but with conflicting results. 3,4 Although Tuft et al 3 noted that eyes with resolved hydrops had significantly higher chances of endothelial rejection episodes compared with those without hydrops (20% vs. 5%; P = 0.02), Akova et al 4 noted fewer allograft rejection episodes in the hydrops group (6% vs. 11%; P = 0.7).…”