Primary graft failure

Primary graft failure with permanent corneal edema. 

  • Occurs when the donor cornea doesn't retain the transparency sufficient for adequate vision. The most common cause is endothelial cells dysfunction.
  • Other causes include sub-optimal condition of donor tissue, intraocular inflammation, hypotony due to ciliary body dysfunction in a traumatized eye, endothelial trauma during surgery, vitreous or iris tissue adherence to endothelium and preexisting glaucoma.

Clinical features

  • Symptoms: hazy or blurred vision
  • Uncommon complication of penetrating keratoplasty.
  • Hazy and graft thickening associated with microcystic edema and multiple stromal or Descemet's folds.

Management:

  • Intensive instillation of topical steroids around the clock to diminish inflammation.
  • Regrafting in cases with persistent corneal edema.
  • Donor button should be sent for pathologic evaluation.