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Updated: Jun 29, 2026

Corneal Donor Tissue Preparation for Endothelial Keratoplasty
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Posterior Segment Risk Factors for Penetrating Keratoplasty Failure.

Glenn J Oh1, Rohit Y Reddy2, Eric J Shiuey3

  • 1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA; Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, USA.

American Journal of Ophthalmology
|June 27, 2026
PubMed
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This summary is machine-generated.

Intraoperative vitreous hemorrhage and silicone oil tamponade after penetrating keratoplasty (PK) significantly increase the risk of PK graft failure. These findings are crucial for managing complex cases and counseling patients on graft prognosis.

Area of Science:

  • Ophthalmology
  • Corneal Surgery
  • Graft Survival Analysis

Background:

  • Penetrating keratoplasty (PK) is a common procedure for corneal blindness.
  • Graft failure remains a significant complication, impacting long-term visual outcomes.
  • Understanding factors influencing PK graft survival is critical for improving patient care.

Purpose of the Study:

  • To investigate the association between intraoperative and postoperative posterior segment factors and the survival of corneal grafts after PK.
  • To identify specific posterior segment variables that predict PK graft failure.

Main Methods:

  • Retrospective cohort study including 835 eyes undergoing PK between 2007 and 2018.
  • Data collection included demographics, ocular history, and intraoperative/postoperative posterior segment factors.
Keywords:
Graft failurePenetrating keratoplastyPosterior segment surgeryVitrectomyVitreous hemorrhage

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  • Multivariable Cox regression analysis was used to identify significant predictors of graft failure.

    • Main Results:

    • Graft failure occurred in 35.0% of cases, with a mean onset of 1.9 years post-PK.
    • Intraoperative vitreous hemorrhage (VH) during PK was strongly associated with graft failure (HR 6.6).
    • Postoperative silicone oil (SO) tamponade after PK also significantly increased graft failure risk (HR 3.2).

    Conclusions:

    • PK graft failure is a serious complication influenced by posterior segment issues.
    • Intraoperative VH and postoperative SO tamponade are significant risk factors for PK graft failure.
    • These findings aid in counseling patients with complex eyes undergoing PK and posterior segment interventions.