Development of a Nomogram to Predict Graft Survival After Penetrating Keratoplasty

Abstract

To develop a nomogram to predict the 3-and 5-year likelihood of graft survival after penetrating keratoplasty (PK) based on preoperative assessment and intraoperative plan. • DESIGN: Retrospective clinical case-control study. • METHODS: Data from 1,029 consecutive PKs in 903 eyes of 835 patients performed at a single tertiary center from May 2007 to September 2018 were extracted from electronic medical records and evaluated for corneal graft failure, defined as irreversible and visually significant graft edema, haze, or scarring. Thirty-seven variables were assessed by multivariable Cox models. A nomogram to predict the probability of graft survival was created. • RESULTS: Mean recipient age was 57.1 ± 22.0 years and mean follow-up was 4.22 ± 3.05 years. Overall, 37.4% of grafts failed during follow-up. Eleven variables were significantly associated with graft failure, including active microbial infection at the time of PK (hazard ratio [HR] = 5.10, 95% confidence interval [CI] 3.53-7.37), intraocular silicone oil at the conclusion of the PK (HR = 4.28, 95% CI 2.38-7.71), history of systemic autoimmune disease (HR = 2.83, 95% CI 1.63-4.90), 4 quadrants of corneal neovascularization (HR = 2.76, 95% CI 1.56-4.86), any prior anterior segment surgery (HR = 2.41, 95% CI 1.55-3.75), and lens status as anterior chamber intraocular lens at the conclusion of surgery (HR = 2.35, 95% CI 1.30-4.26). The nomogram exhibited a concordance index of 0.76 (95% CI 0.74-0.78); internal calibration plots depicted strong correlation between prediction and observation of graft survival. • CONCLUSIONS: PK graft prognosis may be predicted relatively accurately based on 11 variables. Although established from retrospective data, this nomogram would be valuable for data-driven patient counseling prior to corneal transplantation.

Pathological Evaluation of Corneal Regrafts During Ten Years at a Tertiary Referral Center in Tehran, Iran

“…[13,15] The sex ratio in our study was similar to the Indian study where 68% of the patients were men [15,16], but not follow the others studies realized in developed countries. [13,14] Our study showed that the rate of corneal regraft in all transplanted corneas during ten years was 8.55% which is similar to the corneal graft failure rate (5-30%) in other studies [7,8,17,18]. In this study, DALK was the most successful type of grafting with a regraft rate of 1.08% followed by PK (8.32%) and DSAEK (14.98%).…”

“…In our study, in contrast to previous studies, infectious causes (corneal ulcer) of the grafted cornea were the main cause of regrafting [4,5,17]; however, following most studies, endothelial dysfunction had a more signi cant role in corneal regraft [5,6,17,18]. It can be due to climacteric differences or socialcultural conditions of most of our cases who are not able to follow the recommended medical care.…”

Microbial Keratitis Associated With Penetrating Keratoplasty and Scleral Lens Wear: A Case Series

“…24 Patients with autoimmune disease have been shown to have higher risk of PKP failure. 25,26 Autoimmune therapy, used to manage autoimmune disease, suppresses the capability of the immune system to fight infections and may increase the risk of MK. Clearly, further study is needed to assess risk factors of lensrelated complications among patients who have undergone this procedure.…”

Development of a Nomogram to Predict Graft Survival After Descemet Stripping Endothelial Keratoplasty

“…44,45 In the field of ophthalmology, nomograms have been developed to anticipate the prognosis of metastatic uveal melanoma, 46 predict net astigmatism after cataract surgery based on preoperative biometry values, 47 and determine the risk of graft failure after PK. 15 Despite the extensive use of nomograms in this field, this is the first nomogram developed that uses pooled patient data to predict the probability of graft survival after DSEK surgery given various risk factors. Given its wide-reaching prognostic value and potential utility to clinicians and patients alike, external validation of our nomogram is necessary before more generalized application.…”