Glaucoma leads postop complications after PK in Singapore study

Am J Ophthalmol. 2011;151(3):442-448.

Postoperative complications and surgical procedures after corneal grafting bear significantly on long-term graft survival, a large study found.

"Our study suggests that postoperative risk factors may play a greater role in long-term graft survival, as compared with preoperative risk factors, and the lack of attention to this in part may be the result of a paucity of keratoplasty cohorts with accurate long-term tracking of postoperative complications and further surgical interventions," the study authors said.

The prospective study included 901 penetrating keratoplasty procedures performed as part of the Singapore Corneal Transplant Study, an ongoing cohort analysis of more than 2,750 corneal transplant procedures performed at one center in Singapore since 1991. The study included only full-thickness corneal transplantations.

Investigators used univariate and multivariate analysis to determine predictive factors for graft failure.

Study results showed that the most common postoperative complications were glaucoma or elevated IOP (20.7%), allograft rejection (18.2%) and epithelial problems (15.6%). Primary graft failure was identified in 13 eyes (1.4%).

The most common surgical procedures performed after corneal transplantation were glaucoma surgery (7.7%), re-grafting (7.3%) and graft re-suturing (5.7%).

The most significant postoperative predictors for graft failure were graft rejection, microbial keratitis, endophthalmitis and primary disease recurrence.

The most significant preoperative and intraoperative predictors were female gender, graft size less than 7 mm and more than 9 mm, primary diagnosis and preoperative inflammation, the authors reported.