Risk Factors for Graft Rejection Following Endothelial Keratoplasty: Focus on Cystoid Macular Edema

Area of Science:

• Ophthalmology
• Immunology
• Transplantation Science

Background:

• Endothelial keratoplasty, including Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated keratoplasty (DSAEK), is a common procedure.
• Immunologic graft rejection remains a significant complication following endothelial keratoplasty.

Purpose of the Study:

• To investigate risk factors for immunologic graft rejection after endothelial keratoplasty.
• To specifically examine the role of cystoid macular edema (CMO) in graft rejection.

Main Methods:

• Retrospective case review of 3546 eyes undergoing DMEK or DSAEK.
• Univariate and multivariate analyses to identify risk factors for graft rejection.
• Assessment of recipient age, sex, surgical indication, keratoplasty type, glaucoma, and CMO development.

Main Results:

• Graft rejection occurred in 2.9% of DMEK and 4.0% of DSAEK eyes.
• Significant risk factors for rejection included younger recipient age (<71.5 years), presence of glaucoma, and postoperative CMO.
• CMO significantly increased the odds of rejection (OR = 11.09), with rejection occurring a median of 6 months after CMO onset.

Conclusions:

• Younger recipient age, glaucoma, and CMO are significant risk factors for endothelial graft rejection.
• Postoperative CMO is a strong predictor of graft rejection following endothelial keratoplasty.
• Further research is needed to explore the immunologic connection between CMO and graft rejection.