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Long-term outcomes of repeated corneal transplantations: a Dutch registry study

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Session Details

Session Title: Presented Poster Session: Cornea I

Venue: Poster Village: Pod 3

First Author: : M.Dickman THE NETHERLANDS

Co Author(s): :    L. Spekreijse   F. van den Biggelaar   B. Winkens   R. Nuijts     

Abstract Details


The number of repeated corneal transplantations (CT) will continue to rise to meet the needs of an ageing population. To best address this growing demand, we set out to compare the results of repeated CT based on primary disease, indication for repeated CT and surgical technique.


Prospective non-randomized multicenter national registry study (Netherlands Organ Transplantation Registry, NOTR). On behalf of the NOTR study group.


Data on all consecutive repeated CT for Fuchs’ endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK), following a primary penetrating keratoplasty (PK) or endothelial keratoplasty (EK) between 1994 and 2015 was analyzed, with a maximal follow-up of 5 years. Graft survival was analyzed using Kaplan-Meier survival curves, univariable and multivariable Cox regression analysis with primary indication, repeated CT technique, and indication for repeated CT as explanatory factors. Best Corrected Visual acuity (BCVA), spherical equivalent (SE) and refractive astigmatism were compared using Linear Mixed Model analysis


A total of 332 regrafts were analyzed. The number of regrafts increased significantly between 2007-2015 (p<0.001). Five-year regraft survival (60%) was higher for FED vs. PBK (77% vs. 45%, Hazard Ratio [HR] 0.40, p<0.001) and re-EK vs. re-PKP (81%vs.55%, HR 0.51, p=0.045). Multivariable analysis showed no significant differences in regraft survival based on primary indication, surgical technique, and indication for repeated CT. SE and refractive astigmatism were significantly lower after re-EK vs. re-PKP. BCVA improved significantly after repeated CT. After correction for baseline values, BCVA, SE, and refractive astigmatism did not differ significantly between groups at any time-point


Our results show a significant increase in repeated corneal transplantations in the Netherlands between 2007-2015, coinciding with the introduction of endothelial keratoplasty. Regraft survival was significantly lower compared to primary CT. While univariable analysis suggests better outcomes for re-EK compared with re-PKP, multivariable analysis shows no significant difference in outcomes between surgical techniques. This may be due to selective allocation of patients with less favorable prognosis (PBK) to undergo (repeated) penetrating keratoplasty. Nonetheless, considering the clinical benefits of EK (faster rehabilitation, tectonic stability, and lack of suture complications), EK should be considered the method of choice for (repeated) corneal transplantation.

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