Management of primary corneal graft failure

We report two patients with primary graft failure (PGF) from a mutual donor. The surgery in each case was done by a different surgeon experienced in penetrating keratoplasty (PK). The cases were managed differently in the postoperative period with good visual results in both cases. We discuss the various management options available when confronted with apparent PGF in the early postoperative period.

Both patients had excessive graft edema and haze in the immediate postoperative period. Case 1 received a repeat graft after 4 weeks because there was no improvement in graft clarity despite intensive topical steroids. In case 2, repeat surgery was deferred with ultimate gradual improvement in the clarity of the graft over a period of 6 months.

Both patients obtained clear grafts with a visual acuity of 20/30 at 15 months after surgery.

Primary graft failure is a rare complication of PK. Repeat PK is the most definitive therapeutic alternative, although some grafts may clear without any additional surgery. We suggest all cases of PGF be observed for > or = 3-4 weeks for signs of graft clearing before proceeding with a repeated PK.