To compare graft rejection of the first and second eyes after bilateral penetrating keratoplasty.

We performed a retrospective review of the cases of 16 patients who underwent bilateral penetrating keratoplasty. Nonparametric Kaplan-Meier survival analysis was used to account for variable follow-up among patients.

The mean age of the 16 patients (12 M, 4 F) was 39.1 years. Mean follow-up was 89.8 months after surgery in the first eye and 42.8 months after surgery in the second eye. The average time interval between surgery on the first and second eyes was 47.0 months. The indications for surgery were keratoconus (37.5%), corneal dystrophy (25.0%), pseudophakic bullous keratopathy (12.5%), band keratopathy (12.5%), and inflammatory corneal opacity (12.5%). Endothelial rejection occurred in five of the first eyes but was treated successfully, remaining clear until the last follow-up. Endothelial rejections were seen in five of the second eyes, two of which failed. Survival analysis of endothelial rejection showed no significant difference between the first and second eyes; however, survival analysis of the graft failure showed a decreased survival rate of the second eyes compared with that of the first eyes. The best corrected visual acuity at the last follow-up of the second eyes seemed to be worse than that of the first eyes.

Survival analysis of the endothelial rejections showed no significant difference between the first and second eyes. Survival analysis of the graft failure showed decreased survival rate of the second eyes. At the last follow-up the best corrected visual acuity of the second eyes appeared to be worse than that of the first eyes.