Risk factors for corneal regraft in patients on the French waiting list

To determine the frequency of corneal regraft (CR) and to identify risk factors associated with CR for all primary diagnoses, secondary endothelial failure (SEF), and keratoconus.

This survey included 8904 eyes registered on the French national waiting list that underwent keratoplasty between 2000 and 2002.

The frequency of CR was 14.0% for all diagnoses, 16.9% among SEF patients, and 8.3% among keratoconus patients. For all diagnoses, the following factors were found to be independently associated with a significantly increased risk of CR (P < 0.05): primary diagnosis (stromal dystrophy, herpes simplex keratitis, SEF, trauma, and keratoconus with Fuchs dystrophy as reference), vascularization in more than 2 quadrants, planned recipient diameter over 8.5 mm, immunologic disorders, previous lens surgery (aphakic, pseudophakic anterior or posterior chamber intraocular lens), previous surgery for glaucoma or trauma, being grafted in 2001 or in 2002. For SEF patients, the risk factors were younger age, vascularization in more than 2 quadrants, planned recipient diameter over 8.5 mm, immunologic disorders, previous surgery for glaucoma or trauma, associated cataract or dry eye, and graft year. For keratoconus patients, the risk factors for CR were older age, vascularization in more than 2 quadrants, immunologic disorders, and previous lens surgery.

The frequency of CR increased in France over the 2000-2002 time period. Patients presenting the above risk factors should be followed up closely to limit the loss of the first graft.