Penetrating Keratoplasty for Keratoconus With and Without Resolved Corneal Hydrops: Long-term Results

PurposeTo evaluate the long-term risk of endothelial rejection, graft survival, and associated factors following penetrating keratoplasty (PK) for keratoconus, with and without prior resolved corneal hydrops.DesignRetrospective cohort study.MethodsPrimary outcome measures were endothelial rejection-free survival and failure-free survival. Secondary outcome measures were corneal neovascularization following hydrops and complications following PK.ResultsA total of 245 eyes underwent PK for keratoconus with mean follow-up of 5.6 ± 3.6 years. Eyes with prior hydrops (n = 74) had lower endothelial rejection-free survival rates compared with eyes without prior hydrops: 86.5% ± 4.0% vs 86.5% ± 2.6% at 1 year, 61.0% ± 6.2% vs 76.9% ± 3.3% at 5 years, and 45.8% ± 10.1% vs 70.9% ± 4.3% at 10 years, respectively (P = .023). Multivariate analysis identified factors associated with endothelial rejection as age ≤25 years (P = .017), corneal neovascularization (P = .001), donor trephination size >8 mm (P = .017), and poor clinic attendance (P = .015). There was no difference in the failure-free survival rates with and without prior hydrops: 98.6% ± 1.3% vs 97.1% ± 1.3% at 1 year, 97.3% ± 1.9% vs 95.1% ± 1.9% at 5 years, and 97.3% ± 1.9% vs 92.2% ± 2.7% at 10 years, respectively (P = .42). Corneal neovascularization was present at the time of PK in 44.6% of eyes with prior hydrops and 7.6% without prior hydrops (P < .001).ConclusionsCorneal neovascularization, a frequent complication of corneal hydrops, was associated with increased risk of endothelial rejection following PK. However, allograft survival was similar in eyes with and without prior hydrops.