[Non-immunologic factors of failure of penetrating keratoplasties. Prospective study of 119 corneal grafts at the Nantes Hospital Center in 1995].

PURPOSE: A single-center prospective study was carried out in Nantes to evaluate corneal graft outcome, while immunosuppressive treatment was used topically or systemically, during the first year.

METHODS

A cohort of 119 patients underwent penetrating keratoplasty between 1-1-95 and 31-XII-95. Systematic standardized exams were performed at 15 days, 1 month, 4 months, 6 months and 1 year. Grafts were obtained from organo-cultured corneas at +31 degrees C. Intraveinous methyl prednisolone was given at the time of the surgery in most cases (82%). Corticosteroid eye drops are used in all cases and systemic Cyclosporin A was given for high-risk rejection keratoplasties (29.5%).

RESULTS

The clear graft rate at 1 year is 97% for keratoconus, 87.8% for bullous dystrophies and 80.7% for regrafts. The leading causes of graft failure are: graft rejection (25%), endothelial consequences of a non controlled elevated intra ocular pressure (25%) and ocular surface disorders (16%). Prevalence and management of elevated IOP (from 8% to 20%) and ocular surface disorders (from 18% to 43%) are reported over one year.

CONCLUSION

This study points out the great frequency of elevated-IOP-related disorders and ocular surface diseases in corneal graft outcome. They must be tracked down and uncompromisingly treated before and after transplantation.