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We Pursue Eye Research

Corneal Transplants

Penetrating Keratoplasty Outcomes

Cornea Transplant Survival

Patients who received a traditional full thickness transplant at Price Vision Group had an outstanding 80% graft survival rate 10-years after their transplant. This is among the highest long-term survival rate reported in any of the studies conducted around the world, and is only equaled by the 10-year survival rate reported by the Mayo Clinic in Rochester, Minnesota. Our Fuchs’ dystrophy patients had even higher 10-year survival rate of 90%.  Our keratoconus patients had the highest 10-year survival rate of 95%. (Figure – transplant survival rates)

Risk factors for cornea transplant failure

The graft survival rate was twice as high for first-time grafts as it was for regrafts. This shows how important it is to identify risk factors in order to anticipate and prevent failure of the initial transplant.

We found that the risk of cornea transplant failure is highest in the first year after transplantation, and drops to a low but steady rate over longer time periods. We now know that for the first six months after receiving a full thickness cornea transplant, the major risk is ocular surface disease, such as infection or ulcer. There is also a continuing risk over the long term that you might reject you graft. Fortunately, medications are available to treat either ocular surface disease or rejection. Therefore, if you are a transplant patient, you should receive frequent follow-up examinations, and you should come in immediately for a checkup if you notice any problems developing with your graft.

Causes of cornea transplant failure

We found that a major cause of graft failure is endothelial cell failure. The endothelial cells line the inner surface of the cornea and continuously pump fluid to keep the cornea clear. There are a finite number of these cells and they do not get replaced. If the endothelial cells become diseased or damaged or if there are too few of the cells to keep up with the job, the cornea becomes cloudy. Our analysis identified several risk factors for endothelial failure, including small graft size, as well as pre-existing conditions such as diabetes.

Cornea transplants and glaucoma

One of our most significant findings was that glaucoma increased the risk of all three major types of graft failure, including endothelial failure, rejection, and ocular surface disease. Glaucoma is a leading cause of blindness in the United States. Glaucoma affects nearly 1 out of 20 Americans and it targets any age group, even newborns. Scientific literature had previously recognized that elevated intraocular eye pressures associated with glaucoma could cause endothelial cell damage. However, it was surprising to find that glaucoma also increased the risk of rejection and ocular surface disease. This is likely due to the preservatives in the glaucoma eye drops. This finding is important because it may help doctors to more effectively manage their glaucoma patients and the glaucoma medications they prescribe.

Our Publications on Penetrating Keratoplasty

The Foundation’s corneal transplant database helps us learn more and more each day about how to more effectively treat patients who have lost their vision. As listed below, our findings have been published in leading ophthalmology journals so that doctors and patients worldwide can benefit from our research.

  1. Price FW, Price DA, Ngakeng V, Price MO. Survey of steroid usage patterns during and after low-risk penetrating keratoplasty. Cornea 2009;28:865-70. 
  2. Sugar A, Tanner JP, Dontchev M, Tennant B, Schultze RL, Dunn SP, Lindquist TD, Gal RL, Beck RW, Kollman C, Mannis M, Holland E, for the Cornea Donor Study Investigator Group.  Recipient risk factors for graft failure in the cornea donor study.. Ophthalmology 2009; 116: 1023-1028.
  3. Dunn SP, Stark WJ, Stulting RD, Lass JH, Sugar A, Pavilack MA, Smith PW, Tanner JP, Dontchev M, Gal RL, Beck RW, Kollman C, Mannis MJ, Holland EJ; Cornea Donor Study Investigator Group. The effect of ABO blood incompatibility on corneal transplant failure in conditions with low-risk of graft rejection. Am J Ophthalmol. 2009;147:432-8.
  4. Price FW, Price MO, Jordan CS. Safety of incomplete incision patterns in femtosecond laser-assisted penetrating keratoplasty. Journal of Cataract and Refractive Surgery 2008; 34:2099-2013.
  5. Price FW, Price MO. Femtosecond laser shaped penetrating keratoplasty: one-year results utilizing a top-hat configuration. Am J Ophthalmol 2008;145:210-214. 
  6. Price FW, Price, MO. Adult keratoplasty: has the prognosis improved in the last 25 years? Ophthalmology International, 2008; 28:141-146.
  7. Ngakeng V, Hauck MJ, Price MO, Price FW. AlphaCor keratoprosthesis: a novel approach to minimize the risks of long-term postoperative complications. Cornea 2008;27:905-910.
  8. Cornea Donor Study Investigator Group. Donor age and corneal endothelial cell loss 5 years after successful corneal transplantation. Specular microscopy ancillary study results. Ophthalmology. 2008 Apr;115(4):627-632.e8.
  9. Cornea Donor Study Investigator Group. The effect of donor age on corneal transplantation outcome results of the cornea donor study. Ophthalmology. 2008 Apr;115(4):620-626.e6.
  10. Price MO, Price FW.  Efficacy of topical cyclosporine 0.05% for prevention of cornea transplant rejection episodes. Ophthalmology 2006;113:1785-90.
  11. Riddle HK, Price MO, Price FW. Topical anesthesia for penetrating keratoplasty. Cornea, 2004; 23:712-714
  12. Thompson RW, Price MO, Bowers PJ, Price FW. Long-term graft survival after penetrating keratoplasty. Ophthalmology, 2003; 121:1087-1092
  13. Price MO, Thompson RW, Price FW. Risk factors for various causes of failure in initial corneal grafts. Archives of Ophthalmology, 2003; 121:1087-1092.
  14. Dobbins K, Price FW, Whitson WE. Trends in the indications for penetrating keratoplasty in the midwestern United States. Cornea 2000 19(6): 813-816.
  15. Loden JC, Price FW Jr.  Price graft-over-host technique to manage positive pressure during penetrating keratoplasty.  J Cataract Refract Surg. 1998 Jun;24(6):736-8.
  16. Riddle HK, Parker DAS, Price FW. Management of post keratoplasty astigmatism. Current Opinion in Ophthalmology 1998;9(IV):15-28.
  17. Price FW, Whitson WE, Johns SK, Gonzales JS. Risk factors for corneal graft failure. J Refract Surg 1996;12:133-146.
  18. Price FW, Whitson WE, Collins KS. Five-year corneal graft survival. A large, single-center patient cohort. Arch Ophthalmol 1993;111:799-805.
  19. Price FW, Whitson WE. Graft survival in four common groups of patients undergoing penetrating keratoplasty. Ophthalmology 1991;98:322-328.
  20. Price FW, Whitson WE, Marks RG. Progression of visual acuity after penetrating keratoplasty. Ophthalmology 1991;98:1177-1185.