Risk Factors For Corneal Graft Ulcers After Keratoplasty

Purposes To investigate the clinical features and risk factors of corneal graft ulcers after keratoplasty.Methods A retrospective,interventional case series study.1354 cases(1379 eyes)who underwent corneal transplantation in Qingdao Eye Hospital,Shandong Eye Institute from January,2010 to January,2016 were reviewed.According to the occurrence of corneal graft ulcer,the patients were divided into two groups: graft ulcer group and non-graft ulcer group.The chi-square test and the Logistic regression equation were used to analyze the risk factors for graft ulcers in patients after keratoplasty.Results Among the 1354 patients,892 were men and 462 were women,with an average age of 44.89 ± 18.45 years(0.25-86 years).There were 91 patients(91 eyes)in the graft ulcer group and 1263 patients(1288 eyes)in the non-graft ulcer group.The mean age was significantly higher in the graft ulcer group(51.04 ± 17.04 years)than in the non-graft ulcer group(44.45 ± 18.47 years,P<0.05).The ratio of male to female is 1.9: 1 in both groups.Most graft ulcers(59 cases,64.8%)occurred within 1 year after corneal transplantation.15 cases(16.5%)were combined with hypopyon,73 cases(80.2%)with the deep matrix infiltration,and 4 cases(4.4%)with graft perforation.Corneal ulcer following keratoplasty may present as a round or an oval ulcer in shape,and as a central or a peripheral ulcer in location.Most peripheral ulcers were small in size with the length ?4 mm(40/45,88.89%).The incidence of graft ulcers after corneal transplantation was 6.60%(91/1379).The incidence of graft ulcers was 5.90%(62/1050)after penetrating keratoplasty,8.81%(29/329)after lamellar keratoplasty,the difference was not statistically significant(P=0.074).There were 91 cases of graft ulcers,in which 44 cases were graft infection,21 cases were caused by dry eye,MGD,persistent epithelial defects,suture stimulation or other reasons,13 cases were HSK recurrence,8 cases were recurrence of immune keratitis,and 5 cases were combined with chronic graft failure. Graft infection was the primary cause of graft ulcers,with Staphylococcus being the most common pathogen.All suspected risk factors were analyzed by Logistic regression analysis.The results showed that persistent graft epithelial defects(OR=6.600,P<0.01),HSK(OR=3.274,P<0.01),large grafts(OR=2.180,P<0.05),non-fresh corneal donor(OR=1.940,P<0.05)and age(OR=1.015,P<0.05)were the risk factors of graft ulcers after keratoplasty.There was no significant correlation between graft ulcer and patient occupation,diabetes,postoperative immunological rejection,or combined surgery.Conclusions The incidence of graft ulcers following keratoplasty is about 6.6% and most occurred within one year after keratoplasty.Graft infection is the primary cause of graft ulcers,with Staphylococcus being the most common pathogen.Persistent graft epithelial defects,HSK,large grafts(diameter ?9mm),non-fresh corneal donor and age are risk factors of graft ulcers after corneal transplantation.The etiology of corneal graft ulcers is complex and the clinical manifestation is diverse.It is necessary to identify the cause of the graft ulcer as soon as possible and to target for reasonable treatments.