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Graft survival and risk factors of penetrating keratoplasty for microbial keratitis
1Department of Ophthalmology, Arhus University Hospital, Denmark.
Purpose:
To evaluate graft survival rates and prognostic factors in relation to penetrating keratoplasty for microbial keratitis.
Methods:
The records of 95 patients treated with penetrating keratoplasty for microbial keratitis during a twenty-year period were reviewed. Data were analysed by construction of survival curves using the Kaplan-Meier non parametric method.
Results:
The overall survival of a clear cornea was 72% after one year, 71% after two years and 52% after five years. A significantly lower survival rate (p<0.05) was found in the presence of preoperative local risk factors such as wear of contact lenses and trauma and in inflamed eyes. In contrast, systemic diseases like diabetes, cancer or rheumatoid arthritis did not affect survival and neither did recipient age nor the degree of vascularization of the eye. Male donor buttons showed superior survival compared to female ones (p < 0.05), while females seemed to constitute the best recipients. Recurrence rates of microbial keratitis postoperatively were 11%, 16% and 24% after one, two and five years, respectively. Corresponding graft rejection rates were 9%, 15% and 27%.
Conclusions:
Patients suffering from microbial keratitis have a relatively high risk of graft failure. To improve the prognosis care should be taken to minimize local risk factors. Surgery should whenever possible be performed on quiet eyes. The unexpected finding of a better prognosis for male donor buttons might suggest the preferred use of male donors in patients suffering from microbial keratitis, but the observation needs further documentation.
Insights
Graft survival after penetrating keratoplasty for microbial keratitis is 72% at one year, but local risk factors and inflamed eyes reduce success. Male donor grafts showed better survival, suggesting potential for improved outcomes.
Area of Science:
- Ophthalmology
- Transplantation Surgery
- Infectious Diseases
Background:
- Microbial keratitis poses a significant risk for corneal graft failure.
- Penetrating keratoplasty is a common surgical intervention for severe microbial keratitis.
- Understanding prognostic factors is crucial for optimizing graft survival rates.
Purpose of the Study:
- To evaluate graft survival rates following penetrating keratoplasty for microbial keratitis.
- To identify prognostic factors influencing the success of corneal grafts in these patients.
Main Methods:
- Retrospective review of 95 patients undergoing penetrating keratoplasty for microbial keratitis over 20 years.
- Kaplan-Meier survival analysis was employed to assess graft survival.
- Analysis included evaluation of preoperative risk factors, donor/recipient characteristics, and postoperative outcomes.
Main Results:
- Overall clear cornea survival was 72% at 1 year, 71% at 2 years, and 52% at 5 years.
- Preoperative local risk factors (contact lens wear, trauma, inflamed eyes) significantly reduced graft survival (p<0.05).
- Male donor buttons demonstrated superior survival compared to female buttons (p<0.05).
Conclusions:
- Microbial keratitis patients face a high risk of graft failure after penetrating keratoplasty.
- Minimizing local risk factors and operating on quiet eyes are recommended to improve prognosis.
- The potential benefit of using male donor buttons warrants further investigation.