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Large graft size associated with rejection after PK for keratoconus
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A large graft size was the most significant risk factor for transplant rejection after penetrating keratoplasty for keratoconus, a retrospective study found.
Andrew J. Epstein, MD, and colleagues reviewed records for all patients treated with penetrating keratoplasty (PK) for keratoconus over a 3-year period. They identified 23 patients who experienced a first episode of graft rejection. The researchers compared these patients to 69 control patients to determine risk factors associated with rejection.
Only graft size was significantly correlated with rejection risk. Specifically, patients who received grafts with a host trephination size of 8.25 mm or larger had "a nearly sixfold increased risk of rejection (P = .015)," the study authors said.
The researchers found no correlation between other proposed risk factors and rejection, including the following: steroid dose and tapering, different suture techniques, loose sutures or broken sutures at the time of rejection, the number of sutures remaining in the eye upon rejection, and prior grafting in the patient's contralateral eye.
Surgeons diagnosed 70% of the rejection episodes during a scheduled office visit rather than during an emergency visit, the authors noted. Furthermore, 43% of patients had no symptoms of rejection when the graft rejection was detected, they added.
"Physician detection of rejection is paramount, because a graft rejection episode is more often diagnosed at a scheduled office visit than at an emergency visit. Fortunately, progression to graft failure can usually be prevented if treatment is started promptly and intensively," Dr. Epstein and colleagues said.
The researchers found no significant difference in final best corrected visual acuity between patients who experienced rejection and patients in the control group. Of the 23 eyes that experienced graft rejection, 91% did not progress to graft failure, and their central corneas remained clear at last follow-up.
The study is published in the October issue of Cornea.