Factors influencing outcomes of the treatment of allograft corneal rejection.

PURPOSE

To identify patient characteristics influencing treatment outcomes of allograft corneal rejection.

DESIGN

Retrospective case file review.

METHODS

Files containing details of first episode of corneal allograft rejections in patients who underwent penetrating keratoplasty at the Royal Victorian Eye and Ear Hospital, Melbourne, Australia from 1991 to 2006 were reviewed. Cases were divided into 2 groups based on the response to treatment for graft rejection: treatment responders and failures. Main parameters evaluated were demographic characteristics, preoperative clinical profile, donor characteristics, surgical technique, presentation, and treatment of rejection episode.

RESULTS

A total of 235 cases of graft rejection were identified, of which 195 cases (83%) were successfully treated and 40 (17%) failed to respond. Age (P = .08) and gender (P = .61) were comparable in both groups. On univariate analysis, primary diagnosis of keratoconus (P = .04) and phakic lens status at the time of surgery (P = .02) were more common in treatment responders whereas aphakic bullous keratopathy (P ≤ .01), history of glaucoma (P < .01), aphakia (P < .01), and previous grafts (P < .01) were more common among treatment failures. Multivariate analysis revealed that preoperative corneal neovascularization (adjusted odds ratio [aOR] 3.6, 95% CI: 1.3-9.7, P = .01), a larger (>9 mm) donor size (aOR 5.7, 95% CI: 1.3-24.9, P = .02), and corneal edema at presentation (aOR 4.7, 95% CI: 1.7-13.2, P < .01), were independently associated with failure of treatment of graft rejection.

CONCLUSIONS

Treatment failure in cases of corneal allograft rejection is more likely to occur among patients with corneal neovascularization, large donor graft buttons, and corneal edema at presentation.