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Endothelial and lamellar keratoplasty may have lower risk of graft rejection than PK
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 Allan R. Slomovic |
MIAMI — The prevalence of immunologic allograft rejection may be higher with penetrating keratoplasty than with endothelial keratoplasty and deep anterior lamellar keratoplasty, a long-term study showed.
In a 7-year comparative analysis reviewing charts of 1,647 patients who underwent corneal transplant between 2004 and 2010 by two surgeons at Toronto Western Hospital, the overall rejection rate was 7.6%.
"Rejection remains a leading cause of graft failure, and the prevalence of rejection is higher with penetrating than with endothelial or deep anterior lamellar keratoplasty," Allan R. Slomovic, MD, FRCSC, said at the Bascom Palmer Eye Institute 50th Anniversary Scientific Meeting. "Over 90% of patients were symptomatic of their rejection episode. We know that early detection and management of rejection may improve graft survival."
Incidence of rejection for PK was 9.4%, while incidences for EK and DALK were each 3.5%.
"Glaucoma was one of the most common comorbid conditions, identified as a significant risk factor for failure [following rejection in PK and EK]. ... Glaucoma patients require closer monitoring post-keratoplasty," Dr. Slomovic said.
He also noted that a large proportion of patients were not on steroids at the time of rejection.
"If there are no contraindications, penetrating and endothelial keratoplasty patients may benefit from a long-term daily dose of topical corticosteroids," he said.
The study was limited by inability to control for preoperative diagnosis, corticosteroid regimens after transplantation and management of rejection episodes.
- Disclosure: Dr. Slomovic has no relevant financial disclosures.