[Immune reactions to posterior lamellar versus penetrating keratoplasty. A retrospective analysis]

Posterior lamellar keratoplasty is a relatively new surgical procedure for replacing the diseased endothelial layer of the cornea with a healthy layer. There are only few data regarding graft rejection in posterior lamellar keratoplasty. The objective of this paper was to compare posterior lamellar keratoplasty with penetrating keratoplasty for the incidence and risk of graft rejection.

This retrospective study included a total of 204 consecutive patients who underwent penetrating keratoplasty or posterior lamellar keratoplasty at the Department of Ophthalmology, Charité CVK, between 1999 and 2000 and between 2007 and 2009. Complete data were obtained in 160 cases. Statistical analysis was performed using SPSS (Statistical Package for the Social Sciences), version 12.0. Descriptive statistics, χ(2)-test and mean values were used to describe and assess the data.

Out of 160 eyes 29 were treated with posterior lamellar keratoplasty and 131 eyes were treated with penetrating keratoplasty. The incidence of graft rejection was 3.4% in the posterior lamellar group and 29.8% in the penetrating keratoplasty group (χ(2) = 9.02, p < 0.001). Of 44 patients with Fuchs' endothelial dystrophy (FED) 28 underwent posterior lamellar keratoplasty and 16 patients were treated with penetrating keratoplasty. The incidence of graft rejection in this group was 3.6% after posterior lamellar keratoplasty and 18.75% after penetrating keratoplasty.

In this retrospective study with univariate analysis of risk factors, graft rejection was less frequent after posterior lamellar keratoplasty than after penetrating keratoplasty. A comparison of both groups was limited because of different indications for surgery. Posterior lamellar keratoplasty decreased the risk of graft rejection under conditions with the same indications (Fuchs' endothelial dystrophy).