title: Graft rejection and failure following endothelial keratoplasty (DSAEK) and penetrating keratoplasty for secondary endothelial failure.
abstract: OBJECTIVE
  To compare the frequency of rejection and graft failure after Descemet's stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) for secondary endothelial failure.
  
  
  METHODS
  Seventy-eight eyes undergoing DSAEK from 2006 to 2013 and 80 eyes undergoing PK from 1998 to 2013 were included. Indications were endothelial failure due to pseudophakic bullous keratopathy (82%), previous eye trauma (8%), uveitis (4%) or other causes (6%). Rejection episodes and graft failure were recorded, together with preoperative risk factors (glaucoma, neovascularization and active inflammation). Kaplan-Meier survival curves with up to 4 years follow-up were used to compare DSAEK with PK, as well as low-risk with high-risk eyes.
  
  
  RESULTS
  During follow-up, 15% of the PK-treated eyes and 4% of the DSAEK-treated eyes experienced rejection. Graft failure occurred in 8% of the PK-treated eyes and in 7% of the DSAEK-treated eyes. No significant differences were found in the rate of rejection (p=0.11), graft failure (p=0.29) or rejection-related graft failure (p=0.30) between DSAEK and PK in low-risk eyes. In DSAEK, high-risk eyes (mainly with glaucoma) experienced significantly more rejection episodes (p=0.01), graft failures (p=0.04) and rejection-related graft failures (p=0.04) compared with low-risk eyes. No differences were seen between high-risk and low-risk PK-treated eyes (p>0.40).
  
  
  CONCLUSIONS
  In the present, relatively small study, no differences in rejection rate or graft failure were found between DSAEK and PK in low-risk eyes. However, glaucoma seems to increase the risk of graft complications after DSAEK for secondary endothelial failure. Long-term studies of larger samples sizes are needed to confirm this.
authors.affiliation: Department of Ophthalmology, Aarhus University Hospital, Aarhus C, Denmark.
authors.forename: Iben B
authors.initials: IB
authors.lastname: Pedersen
authors.forename: Anders
authors.initials: A
authors.lastname: Ivarsen
authors.forename: Jesper
authors.initials: J
authors.lastname: Hjortdal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003316:Corneal Diseases / Q000209:etiology / Q000601:surgery; D057111:Descemet Stripping Endothelial Keratoplasty / Q000009:adverse effects*; D004728:Endothelium, Corneal / Q000473:pathology; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Descemet's stripping endothelial keratoplasty; corneal transplantation; glaucoma; graft failure; graft rejection; graft survival; penetrating keratoplasty; pseudophakic bullous keratopathy