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Corneal graft failure: an update
  1. Jorge L Alio1,2,
  2. Andrea Montesel1,
  3. Fouad El Sayyad1,
  4. Rafael Ignacio Barraquer3,4,
  5. Francisco Arnalich-Montiel5,
  6. Jorge Luis Alio Del Barrio1,2
  1. 1 Vissum Instituto Oftalmológico de Alicante, Alicante, Spain
  2. 2 Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
  3. 3 Centro de Oftalmología Barraquer, Barcelona, Spain
  4. 4 Institut Universitari Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
  5. 5 Department of Ophthalmology, Ramon Y Cajal University Hospital, Madrid, Spain
  1. Correspondence to Jorge LAlió, Vissum Instituto Oftalmológico De Alicante, C/Cabañal, 1, Alicante 03016, Spain; jlalio{at}


Corneal graft surgery is one of the most successful forms of human solid-tissue transplantation, and nowadays, there is a worldwide expansion of the surgical volume of corneal grafts. This surgery is continuously evolving, with new surgical techniques and postoperative treatments that have considerably increased the chance of survival for the grafts. Despite the high rate of success, corneal transplantation is still complicated by a relevant risk of graft failure. This study investigates the causes that lead to the failure of the different corneal graft surgical techniques and provides an updated synthesis on this topic. A comprehensive review of the main pathological pathways that determine the failure of corneal grafts is provided, analysing the main risk factors and disclosing the survival rates of the principal form of corneal grafts. Our results revealed that penetrating keratoplasty has higher failure rates than lamellar keratoplasty, with immunological rejection being the leading cause of graft failure, followed by late endothelial failure (LEF) and ocular surface disorders. Postoperative glaucoma and dehiscence of the surgical wound represent other important causes of failure. Endothelial keratoplasty showed the lowest rates of failure in the mid-term, with LEF, detachment of the graft and primary graft failure representing the most common pathological reasons for failure.

  • Cornea
  • Treatment Surgery
  • Glaucoma

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  • Funding This study has been supported by the Red Temática de Investigación Cooperativa en Salud (RETICS), reference number RD16/0008/0012, funded by the Instituto de Salud Carlos III and co-funded by the European Regional Development Fund (ERDF), “A way to make Europe”.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.