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Primary graft failure: a case control investigation of a purported cluster
1Ophthalmic Consultants of Boston, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston 02114.
Abstract:
Primary graft failure is a rare but major complication of penetrating keratoplasty. An apparent clustering of four cases during a 1-month period led to a review of all 778 keratoplasties performed by nine surgeons at Massachusetts Eye and Ear Infirmary from July 1, 1986 to June 30, 1988. The objectives of this study were (a) to investigate the possibility that cases of primary graft failure occurred in clusters within their physical environment of space, time, and personnel and (b) to determine the frequency of and evaluate possible risk factors for primary graft failure. Twenty-one cases of primary graft failure were found, resulting in an incidence rate of 2.7% during this period. A 13.3% incidence of primary graft failure was found in donor mates, suggesting improper tissue preparation. The charts and eye bank records of the 21 cases and 84 age-matched controls, randomly selected from the group of all keratoplasties, were reviewed for donor-, recipient-, surgeon-, and surgery-related characteristics. Improper tissue preparation was not associated with primary graft failure. An individual surgeon was the most significant risk factor [odds ratio = 6 (95% CI: 2.1-17.0)].
Insights
Primary graft failure after penetrating keratoplasty is rare. This study found an individual surgeon was the most significant risk factor for this complication, highlighting the need for surgeon-specific quality control in corneal transplantation.
Area of Science:
- Ophthalmology
- Transplantation Surgery
- Epidemiology
Background:
- Primary graft failure is a serious complication following penetrating keratoplasty.
- An observed cluster of cases prompted a detailed investigation into potential contributing factors.
Purpose of the Study:
- To investigate the spatial, temporal, and personnel clustering of primary graft failure cases.
- To determine the incidence rate and identify risk factors associated with primary graft failure in penetrating keratoplasty.
Main Methods:
- Retrospective review of 778 penetrating keratoplasties performed between July 1986 and June 1988.
- Analysis of 21 primary graft failure cases and 84 age-matched controls.
- Evaluation of donor, recipient, surgeon, and surgical factors.
Main Results:
- The overall incidence of primary graft failure was 2.7%.
- A higher incidence in donor mates (13.3%) was initially suspected but not statistically confirmed as a risk factor.
- An individual surgeon was identified as the most significant risk factor (odds ratio = 6).
Conclusions:
- While donor tissue preparation was examined, it was not found to be a significant risk factor.
- Surgeon-specific factors represent the most critical identifiable risk for primary graft failure in this cohort.
- Further investigation into surgeon-related variables is warranted to improve outcomes in corneal transplantation.