The prognosis of keratoplasty after previous graft failures in adults
First Author: S.Al-swailem SAUDI ARABIA
Co Author(s): O. Ben Husain
To determine graft survival and visual outcome after repeat penetraing keratoplasty (PKP).
Retrospective, tertiary eye hospital
Review of the medical records of patients who underwent repeat PKP between 1 January 2007 and 31 December 2011. Exclusion criteria were initial keratoplasty performed elsewhere, previous lamellar graft, a clear graft with follow-up less than1 year, third and further regrafts, and age less than18 years.
out of 226 repeat PKP performed, 85 repeat PKP (of 85 patients) were included. The median age at the time of regraft was 59.2 years (range 21.8–86.1). The most common cause of performing initial PKP was bullous keratopathy (35.3%) followed by keratoconus (23.5%) and therapeutic/tectonic (T/T) graft (20%). Median follow-up was 63.5 and 30 months for clear and failed graft, respectively. Failure were due to recurrence (36.5%) and rejection (49%). Secondary glaucoma (p = 0.001) and corneal vascularization (p = 0.01) were the most common risk factors associated with rejection. Overall five-year survival rate was 46%. The best graft survival was in eyes with an original diagnosis of keratoconus (80%) and the worst was in eyes with T/T grafts (11.8%). Visual acuity ≥ 20/60 achieved in 28% in the first year and 19% at 5 years. Poor vision less than 20/200 (27%) were mainly associated with the presence of glaucoma, corneal ulcer, retinal detachment, and optic nerve atrophy.
Although the prognosis for repeat PKP is poorer than that of initial PKP, reasonable outcomes can be obtained with repeat PKP with careful case selection.