Corneal graft failure: an update.

Area of Science:

• Ophthalmology
• Transplantation Surgery
• Biomedical Engineering

Background:

• Corneal transplantation is a successful solid-tissue transplant with increasing global surgical volume.
• Advancements in surgical techniques and postoperative care enhance graft survival rates.
• Despite successes, graft failure remains a significant complication in corneal transplantation.

Purpose of the Study:

• To investigate the causes of corneal graft failure across different surgical techniques.
• To provide an updated synthesis of pathological pathways leading to graft failure.
• To analyze risk factors and survival rates for principal corneal graft types.

Main Methods:

• Comprehensive literature review of corneal graft failure.
• Analysis of pathological pathways and risk factors for graft failure.
• Comparison of failure rates and causes among different keratoplasty techniques.

Main Results:

• Penetrating keratoplasty exhibits higher failure rates compared to lamellar keratoplasty.
• Immunological rejection is the leading cause of graft failure, followed by late endothelial failure (LEF) and ocular surface disorders.
• Endothelial keratoplasty demonstrates lower mid-term failure rates, with LEF, graft detachment, and primary graft failure as key reasons.

Conclusions:

• Understanding graft failure mechanisms is crucial for improving corneal transplantation outcomes.
• Lamellar keratoplasty techniques, particularly endothelial keratoplasty, offer better mid-term survival rates.
• Addressing immunological rejection, LEF, and ocular surface disorders are key to reducing corneal graft failure.