Evolution of Corneal Graft Survival Over a 30-Year Period and Comparison of Surgical Techniques: A Cohort Study

{PURPOSE: To compare graft survival between 3 10 year periods and according to surgical techniques performed in the last years. DESIGN: Cohort study. METHODS: SETTING: Regional center (Besancon University Hospital, France). PATIENTS: All 1132 patients operated on between 1983 and 2014. Graft and patient baseline characteristics, risk factors for failure, surgical procedures, and postoperative corneal status were collected. MAIN OUTCOME MEASURES: Five-year survival rate in the whole cohort; 1-year and 3-year survival rates, respectively, among 88 patients with endothelial dystrophy (ED) or postoperative bullous keratopathy (PBK) operated on using endothelial lamellar keratoplasty (ELK) or penetrating keratoplasty (PK), and among 56 patients with keratoconus operated on using anterior lamellar keratoplasty (ALK) or PK. RESULTS: Between the 1983-1993 and the 20042014 periods, overall 5-year graft survival rate increased from 61.4% to 76.5% (P=.0004). The main prognostic factors were preoperative diagnosis, graft endothelial density, and postoperative lens status. After adjusting for these factors, difference, in survival rates was no longer significant (hazard ratio 0.90 for the second and 1.17 for the third period, compared to the first