What is the 5-year graft survival rate for PKP by diagnosis?

PKP 5-year survival: keratoconus 97%; Fuchs dystrophy 95%; pseudophakic bullous keratopathy 85%; regraft <75%; high-risk (vascularized cornea, previous rejection): <50% without HLA matching; DMEK achieves better endothelial survival and fewer rejection episodes than DSAEK.

What symptoms indicate corneal graft rejection?

RSVP mnemonic: Redness, Sensitivity to light, Visual decrease, Pain; endothelial rejection most common and serious; requires immediate high-dose topical steroids (dexamethasone 0.1% hourly); IV methylprednisolone for severe rejection episodes.

How long should topical steroids be continued after PKP?

Minimum 12-18 months, often indefinite (life of graft); taper from hourly to QID, then BID to OD based on absence of inflammatory signs; abrupt steroid discontinuation is a major rejection trigger; prednisolone acetate 1% is most commonly used formulation.

When is HLA matching beneficial for corneal transplants?

HLA-A, B, DR matching reduces rejection risk in high-risk corneal transplants (vascularized, regrafts, multiple prior rejections); NHS Blood and Transplant applies matching for high-risk cases; routine PK in clear corneas with no vascularization - HLA matching not necessary.

What is DMEK vs DSAEK and when is each preferred?

DSAEK: transplants posterior stroma + Descemet + endothelium (thicker graft, lower displacement rate); DMEK: transplants Descemet + endothelium only (better visual outcomes, lower rejection rate); DMEK preferred for Fuchs; DSAEK for pseudophakic bullous keratopathy and complex eyes.

Corneal Transplant Graft Survival and Rejection Risk Calculator

Estimates penetrating keratoplasty (PK) and DSAEK/DMEK graft survival by diagnosis, recipient risk factors (neovascularization, prior rejection, glaucoma), HLA matching, and topical steroid adherence requirement.

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