The influencing factors and characteristics of corneal graft endothelial decompensation after penetrating keratoplasty

PURPOSE. To investigate the influencing factors and characteristics of endothelial decompensation after penetrating keratoplasty (PK). METHODS. We investigated the indications for PK, the onset times of postoperative endothelial decompensation, and the prevalence of risk factors in 151 eyes from 3031 eyes treated with PK in our center from 1993 to 2007. RESULTS. Ocular trauma (22%), repeated PKs (17%), and chemical and thermal burns (10%) were the most common PK indications with the occurrence of endothelial decompensation. Although herpes simplex keratitis (HSK) accounted for 13% in the PK indications with endothelial decompensation, its incidence was actually statistically low (p=0.040) due to the high percentage of HSK in the cases treated with PK (20%). Most endothelial decompensation occurred within 2 years (66%), which may be related to early rejection (p=0.038). Endothelial decompensation occurred within 2 years in all patients due to congenital corneal endothelial dystrophy and iridocorneal endothelial syndrome; more than 70% due to ocular trauma and chemical and thermal burn occurred within 2 years; most cases due to mycotic corneal ulcer (100%) and bullous keratopathy (93%) occurred within 5 years. In the HSK group, endothelial decompensation occurred most at 10.5 and 126 months (median time). The prevalence of risk factors depended on the indicator for PK (p=0.027), and rejection was the highest (41%) among all factors. CONCLUSIONS. Patients with different indicators for PK had different incidences and onset times for endothelial decompensation, which could help clinicians to follow-up and treat patients with PK reasonably and improve the basic research of pathogenesis of endothelial decompensation. (Eur J Ophthalmol 2010; 20: 21-8)