title: Graft rejection and graft failure after anterior lamellar versus penetrating keratoplasty.
abstract: OBJECTIVE
  To compare anterior lamellar keratoplasty (ALK) with the reference surgical technique (penetrating keratoplasty [PK]) for risk of rejection.
  
  
  METHODS
  Retrospective, comparative case series.
  
  
  METHODS
  setting: Institutional. patients: One hundred forty-nine consecutive ALK procedures (ALK group) and 149 matched PK procedures (PK group) performed for optical indication in eyes with corneal diseases not involving the corneal endothelium (ie, keratoconus, scars after infectious keratitis, stromal dystrophies, and trauma). main outcome measures: Three-year graft survival and cumulative incidence of rejection episodes.
  
  
  RESULTS
  The 3-year overall graft survival was 98.3% in the ALK group and 94.3% in the PK group (P = .03). The 3-year cumulative incidence of irreversible rejection was 0.0% in the ALK group and 5.2% in the PK group (P = .02). The 3-year cumulative incidence of rejection episodes was 10.0% in the ALK group and 23.2% in the PK group (P = .01). The average graft-to-rejection episode time was 21.6 ± 22.0 months in the PK group and 19.4 ± 12.7 months in the ALK group (P = .76).
  
  
  CONCLUSIONS
  ALK techniques dramatically decrease the risk of irreversible endothelial and stromal rejection after corneal transplantation. Immune-mediated rejection episodes are observed after ALK, but its lower graft failure rate compared with PK is at least partly the result of the absence of endothelial rejection. In addition, the incidence of rejection episodes after ALK was 50% less than that observed after PK.
authors.affiliation: Centre Hospitalier National d'Ophtalmologie des XV-XX, Institut de la Vision, Pierre & Marie Curie University Paris 06, 28 rue de Charenton, Paris, France. vincent.borderie@upmc.fr
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Borderie
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Guilbert
authors.forename: Olivier
authors.initials: O
authors.lastname: Touzeau
authors.forename: Laurent
authors.initials: L
authors.lastname: Laroche
mesh_terms: D000328:Adult; D000368:Aged; D003316:Corneal Diseases / Q000601:surgery; D016039:Corneal Transplantation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015994:Incidence; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors