The Montgomery Lecture. Some factors which affect the visual outcome of corneal transplantation

Corneal transplantation, which began in Dublin early in the nineteenth century, is now widely practised. Most grafts are done for visual reasons, some to manage corneal destructive disease. The factors associated with allograft rejection are well known, but a clear graft does not mean that the transplantation procedure has been successful. Successful corneal grafts enable patients to improve their life-style. To achieve this, the graft must be transparent and free of optical aberrations, the eye must be capable of achieving good vision, and the patient must have a life-style which would benefit from a successful functioning graft. A study of patients who have had corneal grafts identified the presence of a functioning graft, the lack of need for a contact lens, and the achievement of visual acuity in the operated eye which exceeds that of the contralateral eye, as requirements for patient satisfaction.