Corneal grafts are vital to improving vision and quality of life in affected patients, but are often vulnerable to complications that undermine success. In a recent study, researchers decided to investigate real-world outcomes of these procedures.

All corneal transplant procedures studied—nearly 13,000—were registered in the European Cornea and Cell Transplantation Registry and graft survival of primary corneal transplants.

Graft survival rate of corneal transplants was high (89%), but differed considerably between indications and techniques. Transplants for keratoconus had the best graft survival of all indications, measuring at 98% at two years postoperatively. The authors noted this might be attributed to “a low graft rejection rate in this patient group with a few local and systemic comorbidities.”

Surgeries for corneal dystrophies also fared well, with success rates of 92% in patients with Fuchs’ endothelial dystrophy and slightly better (94%) for those without. Survival rates in infectious keratitis (82%), pseudophakic bullous keratopathy (82%), regraft (82%) and trauma (80%) all proved the merit of such an approach.

Visual acuity improved overall among study subjects, but the risk of losing vision ranged from 7% to 58%. In eyes with specified graft failure, endothelial decompensation was the most common cause at 34%, followed by primary graft failure at 23%.

“The high failure rate in the immediate postoperative period after Descemet’s membrane endothelial keratoplasty (DMEK) likely reflects a real-world learning curve,” the authors noted in their study. “Because DMEK is a relatively new surgical technique, it will be interesting to follow-up on its outcomes, especially given reports on lower rejection rates that could have a positive impact on long-term graft survival.”

Dunker LS, Armitage J, Armitage M, et al. Outcomes of corneal transplantation in Europe: report by the European Cornea and Cell Transplantation Registry. J Cataract Refract Surg. 2021;47:780-85.