title: Postoperative risk factors influencing corneal graft survival in the Singapore Corneal Transplant Study.
abstract: OBJECTIVE
  To determine postoperative risk factors that influence long-term corneal graft survival.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Nine-hundred one consecutive penetrating keratoplasty procedures for optical, therapeutic, or tectonic indications from the Singapore Corneal Transplant Study. Univariate and multivariate analysis was performed for postoperative risk factors; Cox proportional hazards regression with a time-dependent covariate was used for preoperative, intraoperative, donor, and postoperative risk factors in a combined model.
  
  
  RESULTS
  Raised intraocular pressure (20.7%) was the most common complication, followed by rejection (18.2%), whereas glaucoma surgery (7.9%) and repeat grafting (7.3%) were the most common procedures after penetrating keratoplasty. The primary graft failure rate was 1.4%, and late failure was seen in 9.4% of eyes. In the combined regression model, rejection (hazard ratio [HR], 3.4; P = .00), microbial keratitis (HR, 3.6; P = .00), endophthalmitis (HR, 7.7; P = .00), primary disease recurrence (HR, 73.9; P = .00), wound dehiscence (HR, 2.8; P = .02), lid surgery (HR, 2.3; P = .02), glaucoma surgery (HR, 2.46; P = .02), and repeat grafting (HR, 3.2; P = .00) were the significant postoperative failure predictors; the significant preoperative and intraoperative factors identified were female gender, graft size of less than 7 mm and more than 9 mm, primary diagnosis, preoperative inflammation, and preexisting perforation.
  
  
  CONCLUSIONS
  Postoperative complications and operative procedures after grafting have an adverse effect on graft survival.
authors.affiliation: Singapore National Eye Centre, Singapore, Republic of Singapore.
authors.forename: Arundhati
authors.initials: A
authors.lastname: Anshu
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Lim
authors.forename: Hla Myint
authors.initials: HM
authors.lastname: Htoon
authors.forename: Donald T H
authors.initials: DT
authors.lastname: Tan
mesh_terms: D000367:Age Factors; D003315:Cornea / Q000502:physiology*; D003316:Corneal Diseases / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D012846:Singapore