Statistical Analysis of Risk Factors in High-Risk Penetrating Keratoplasty

Abstract

To identify and evaluate risk factors that contribute to the development of graft rejection after corneal transplant, and to create a predictive model for this condition in patients at high risk.Patients and methods. This study included the outcomes of penetrating keratoplasty in 120 cases (108 patients) from the Moscow City Ophthalmological Center (MCOC), “Botkin Hospital” of the Moscow Department of Health, from July 2020 to December 2021. All procedures were classified as high risk for graft disease development. The patients were followed for 12–36 months after surgery. To assess the relationship between transplantation outcomes (loss of transparency/engraftment) and other factors, local and general health conditions were evaluated, as well as donor material characteristics. Kaplan-Meyer and Cox regression methods were used to analyze graft survival and risk factors for graft disease.Results. The multivariate analysis revealed several significant indicators of development graft disease. Among these, the following factors were found to significantly increase the risk of graft failure: a high level of vascularization in the recipient’s eye, a history of ophthalmological or systemic conditions, the size and location of the pathology in the cornea, and the presence of an identified pathogen. Based on these findings, a new method for predicting graft failure in patients undergoing penetrating corneal transplantation has been proposed (RF Patent No. 2023109334, issued on April 13, 2023).Conclusion. In assessing the risk factors for corneal graft disease during high-risk operations, factors of the local and general somatic status of the operated eye turned out to be significant. The proposed method is simple, accessible and practical for assessing the prospects for transparent engraftment in patients in the high-risk keratoplasty group.