Primary Endothelial Failure, After Penetrating Keratoplasty

Synonyms

Primary graft failure

Definition

Corneal graft edema starting on the first postoperative day which does not clear within 2 months (Mannis et al. 2013).

Etiology

The most common etiology is usually a low endothelial cell count, often from manipulation of the graft during surgery (Wilhelmus et al. 1995). Other causes include postoperative inflammation, hypotony, glaucoma, and vitreous and iris adhesions to the endothelium. For endothelial keratoplasties, poor adhesion at the graft-host interface is another cause.

Occurrence

Occurs in approximately 1 % of graft failures (Mannis et al. 2013).

Classification

For penetrating keratoplasties, primary failure consists of grafts that do not clear postoperatively. For endothelial keratoplasties, they are grafts that do not reattach or never clear postoperatively (Oster et al. 2009). Both present with microcystic edema, often with Descemet’s folds. Patients often complain of blurry vision and may have foreign body sensation and...