Purpose: To evaluate corneal graft survival after onset of severe endothelial rejection after penetrating keratoplasty (PK).
Design: Retrospective case series.
Participants: One hundred fifty-six patients (161 PKs) treated at a single center.
Methods: Retrospective review of the medical records of every case of severe endothelial rejection admitted to the King Khaled Eye Specialist Hospital (KKESH) between January 1, 1998 and December 31, 2002. Patients for whom PK had been performed at KKESH between June 1, 1983 and December 31, 2002 and in whom at least 3 months of follow-up was available were included in the statistical analysis.
Main outcome measure: Graft survival.
Results: One hundred fifty-seven PKs (152 patients) met the inclusion criteria and were included in the statistical analysis. Four PKs (4 patients) were excluded from the statistical analysis due to inadequate follow-up. The rejection episode was reversed during the first 3 months in 90 grafts (57.3%). By Kaplan-Meier analysis, graft survivals were 42.6% at 1 year and 36.1% at 3 years. The surgical indication for PK significantly correlated with likelihood of reversibility (P<0.001) and long-term graft survival (P<0.001). Risk factors associated with an increased risk of postrejection graft failure included increasing donor age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.04-1.24; P = 0.004), increasing patient age (OR, 1.23; 95% CI, 1.11-1.35; P<0.001), and history of rejection episodes (P = 0.002).
Conclusion: Endothelial rejection is a serious complication of PK, with a high risk of graft failure.