Clear graft survival and immune reactions following emergency keratoplasty.
BACKGROUND
Emergency penetrating keratoplasty is said to have a poorer outcome than conventional keratoplasty. We performed a retrospective analysis of 272 cases of emergency keratoplasty to evaluate this hypothesis.


METHODS
We analysed 272 cases of emergency keratoplasty and compared the results with a control group of 1,257 scheduled normal-risk keratoplasties and 407 scheduled high-risk keratoplasties. Kaplan-Meier estimations were performed to estimate the percentage of clear graft survival and development of immune reactions. Indications for emergency keratoplasty were microbial diseases (n=109, acanthamoeba, bacteria, fungi), herpes simplex virus infections (n=83), ulcers due to immunological diseases (n=63), and 17 cases of ulcers of unknown origin.


RESULTS
Within 1,500 postoperative days, grafts following emergency keratoplasty suffered statistically significantly more graft failures (clear graft survival, 67.9 vs. 86.9%, P<0.01) and immune reactions (grafts free from immune reactions, 62.8 vs. 78.6%, P<0.01) than grafts following scheduled, normal-risk keratoplasty. There was no statistically significant difference between emergency and scheduled high-risk keratoplasties (clear graft survival, 67.9 vs. 70.2%, and grafts free from immune reactions, 62.8 vs. 66.8%). For emergency keratoplasties, systemic immunosuppression (with cyclosporin A and/or mycophenolatmophetil) had a statistically significant positive effect on clear graft survival (77.4 vs. 63.5%, P=0.01), but not on the development of immune reactions (62.8 vs. 62.3%). A sub-group analysis showed that the effect on clear graft survival was mainly an effect on the underlying systemic immunological disease that had lead to emergency keratoplasty.


CONCLUSIONS
This retrospective analysis revealed that clear graft survival is limited following emergency keratoplasty. As in high-risk situations, systemic immunosuppression may be the key to improving prognosis following emergency keratoplasty in the long run.
Maier
P
P
University Eye Hospital, Killianstr. 5, 79106, Freiburg, Germany. philip.maier@uniklinik-freiburg.de
Böhringer
D
D
Reinhard
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003315:Cornea / Q000502:physiology*; D003316:Corneal Diseases / Q000601:surgery; D015925:Cryopreservation; D016572:Cyclosporine / Q000008:administration & dosage; D004638:Emergency Treatment; D006084:Graft Rejection; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007107:Immune System / Q000502:physiology; D007108:Immune Tolerance; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015948:Keratoplasty, Penetrating; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D009924:Organ Culture Techniques / Q000379:methods; D009926:Organ Preservation / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid