Primary Graft Failure

• Occurs when the donor cornea doesn't retain the transparency sufficient for adequate vision. The most common cause is endothelial cells dysfunction.
• Other causes include sub-optimal condition of donor tissue, intraocular inflammation, hypotony due to ciliary body dysfunction in a traumatized eye, endothelial trauma during surgery, vitreous or iris tissue adherence to endothelium and preexisting glaucoma.

Clinical Features

• Symptoms: hazy or blurred vision
• Uncommon complication of penetrating keratoplasty.
• Hazy and graft thickening associated with microcystic edema and multiple stromal or Descemet's folds.

Management

• Intensive instillation of topical steroids around the clock to diminish inflammation.
• Regrafting in cases with persistent corneal edema.
• Donor button should be sent for pathologic evaluation.