Race and presence of glaucoma may increase risk of graft failure after DSEK

Br J Ophthalmol. 2009;93(3):391-395.

The risk of graft rejection after Descemet's stripping endothelial keratoplasty is low, but patient-specific characteristics may contribute to increased risk.

In 598 DSEK cases from a single center, graft rejection occurred in 54 patients of 48 eyes after 2 years of follow-up. The greatest number of rejections occurred in the first 3 months after surgery (n = 11).

Overall, the study found a 3.6% probability of having an immunological rejection within the first 6 months, a 7.6% probability in the first year and a 12% probability within 2 years. However, the relative risk of graft rejection in the study was five times higher in African-American patients. According to the study, this finding is consistent with findings from previous studies noting a higher risk of graft rejection after penetrating keratoplasty.

There was also a higher relative risk of graft rejection among patients with pre-existing glaucoma or steroid-responsive hypertension. The risk was nearly double in these patients, according to the study.

A graft rejection episode also appeared to have no influence on whether a fellow eye would experience a graft rejection. The relative risk for graft rejection was no higher in fellow eyes undergoing DSEK in patients who had experienced a previous rejection compared with patients who had not had a rejection.