One-Year Graft Survival And Clinical Outcomes In 200 Consecutive Keratoplasties At A Tertiary Referral Center In Spain

To determine graft survival and visual outcomes in terms of best-corrected visual acuity (BCVA) over one year of follow-up in patients who underwent corneal transplantation at the Ophthalmology Department of University Clinical Hospital of Valladolid between 2021 and 2023.

The University Clinical Hospital of Valladolid (HCUV) is considered a national reference center for corneal transplantation, allowing it to manage a wide variety of techniques and a high volume of procedures. In recent years, a significant shift has been observed towards lamellar techniques in corneal transplantation. Given the relevance of this transition and the extensive experience of the HCUV, it is important to analyze the outcomes in terms of graft survival and visual recovery. 

A retrospective, observational, single-center study was conducted, reviewing medical records of patients over 18 years of age who underwent any type of keratoplasty between 2021 and 2023. Collected variables included demographic data, preoperative clinical characteristics, donor cornea features, and postoperative outcomes in terms of Best-corrected visual acuity (BCVA) and corneal graft survival at one year. Descriptive and bivariate statistical analyses were performed, along with Kaplan-Meier survival curves.

A total of 200 keratoplasty were analyzed. The majority of patients were women (58.5%), with a mean age of 66.7 years. Descemet membrane endothelial keratoplasty (DMEK) was the most frequently performed technique (54.0%), followed by Descemet stripping automated endothelial keratoplasty (DSAEK, 25.5%) and penetrating keratoplasty (PK, 14.0%). The leading surgical indication was Fuchs endothelial dystrophy (39%), followed by pseudophakic bullous keratopathy (23%) and previous corneal graft failure (20%). Corneal graft failure occurred in 29 cases within the first year, resulting in an overall one-year survival rate of 85.5%, and 90% specifically in the DMEK group. Overall, visual acuity improved in 71% of cases. 

Keratoplasty achieved favorable one-year outcomes in terms of corneal graft survival. DMEK demonstrated the highest success rates, reinforcing its role as the preferred technique for endothelial pathologies such as Fuchs endothelial dystrophy and pseudophakic bullous keratopathy. Prior ocular surgeries and early postoperative interventions were identified as significant risk factors for corneal graft failure. Previous ocular surgeries (except keratoplasty) and early postoperative surgeries (<1 month) were associated with graft failure during the first year of follow-up.