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Causes and Risk Factors for Graft Failure in Surgeries Performed by Physicians in Fellowship Training

Purpose: To determine the incidence, causes, and risk factors of penetrating keratoplasty failure. Methods: A retrospective study was carried out in 213 penetrating keratoplasties (194 patients) between January 1995 and January 2001 at the Cornea Section of the Ophthalmology Service at the School of Medicine, Federal University of Uberlândia MG, Brazil. Follow-up time for 213 surgeries ranged from 2 to 68 months (mean 29.05 ± 17.17 months). Results: Two hundred thirteen surgeries were evaluated, and 54 (25.3%) failed. Risk factors for developing graft failure were regraft [relative risk (RR) = 2.9734], trauma (RR = 1.4602) and herpes (HSV) (RR = 1.3400). Patients with previous glaucoma (P < 0.00001), previous ocular surgery (P < 0.0008), combined procedures (P < 0.001), and glaucoma after penetrating keratoplasty (P < 0.00001) had an increased the rate of graft failure. The main causes of graft failure were irreversible rejection (50%), glaucoma (20.3%), primary graft failure (16.6%), and infection (3.8%). Conclusion: Graft failure is a common problem in cornea transplantation. Etiology and pre- and postsurgical risk factors are important in the prognosis of keratoplasties.