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Ophthalmology. 2013 Jul;120(7):1360-5. doi: 10.1016/j.ophtha.2012.12.036. Epub 2013 Mar 24.

Immunologic graft rejection in descemet's stripping endothelial keratoplasty and penetrating keratoplasty for endothelial disease.

Author information

1
Department of Ophthalmology, Hofstra North Shore-Long Island Jewish School of Medicine, Great Neck, New York 11021, USA. ice202@gmail.com

Abstract

OBJECTIVE:

To evaluate and compare the cumulative incidence and risk factors for first-episode immunologic graft rejection in Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) and to identify potential risk factors for rejection.

DESIGN:

Retrospective chart review.

PARTICIPANTS:

All patients who underwent PK or DSAEK for endothelial disease at the Department of Ophthalmology, North Shore LIJ, between January 2004 and June 2010.

METHODS:

One hundred sixty-nine PK cases and 122 DSAEK cases were reviewed. All patients had a minimum of 3 months of follow-up, with median follow-up of 36 months in the PK group and 29 months in the DSAEK group.

MAIN OUTCOME MEASURES:

Cumulative incidence of first-episode immunologic graft rejection in PK and DSAEK cohorts. Risk factors for graft rejection were reviewed.

RESULTS:

Cumulative incidence of rejection was not significantly different between the DSAEK and PK cohorts (P<0.1324). However, among patients without glaucoma, the risk of rejection in PK was higher than that in DSAEK (hazard ratio [HR], 5.56). Prior incisional glaucoma surgery imparted a 3.15 times greater risk of rejection regardless of transplant type. Phakic patients were more likely to experience rejection than patients with a posterior chamber intraocular lens (HR, 3.23; P<0.0266), but not more likely than those with an anterior chamber intraocular lens or who were aphakic. Graft failure occurred within 6 months in 31% of PK rejections and none of the DSAEK rejections.

CONCLUSIONS:

Descemet's stripping automated endothelial keratoplasty and PK did not show a statistically significant difference in the incidence of rejection; however, among nonglaucomatous eyes, there were significantly fewer rejections in those that underwent DSAEK.

PMID:
23531352
DOI:
10.1016/j.ophtha.2012.12.036
[Indexed for MEDLINE]

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