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


CONCLUSIONS
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.
Vabres
B
B
Service d'Ophtalmologie, Hôtel-Dieu, CHU Nantes.
Duffas
M
M
Stork
L
L
Péchereau
A
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology*; D006785:Hospitals, University; D006801:Humans; D007429:Intraocular Pressure; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies