Clinical research of repeat keratoplasty

Abstract

ObJective To investigate the major etiologies and outcomes of repeat penetrating keratoplasty (RPKP) and repeat lamellar keratoplasty (RLKP).Methods Retrospective review of 23 eyes from 21 patients underwent RPKP and RLKP from January 1,2009 through December 31,2011 in Department of Ophthalmology of the First Affiliated Hospital of Chongqing Medical University,to determine the major etiologies,time interval between 2 grafts,influencing factors and outcomes for RPKP and RLKP.Results Eleven eyes from 11 patients were involved in RPKP.Primary etiologies for RPKP were infectious keratitis (5 cases,45.5％),leucoma of cornea (3 cases,27.3％),corneal degeneration (2 cases,18.2％) as well as chemical burn (1 case,9.1％).The direct causes of RPKP were corneal rejection (6 cases,54.5％),perforation and ulcer of transplant (2 cases,18.2％),CCAD (2 cases,18.2％) and recurrence of primary disease (1 case,9.1％).Twelve eyes from 10 patients were involved in RLKP.Primary etiologies for RPKP were non-infectious keratitis (5 eyes,41.7％),infectious keratitis (3 eyes,25％),chemical burn (2 eyes,16.7％),corneal degeneration and dystrophy,as well as thermal burn (1 eye,8.3％).The direct causes of RLKP were corneal rejection (8 eyes,66.7％),recurrence of primary disease,leucoma of cornea (3 eyes,25％),and CCAD (1 eye,8.3％).All patients were followed form 9 to 32 months,with an average of (22.0±7.9) months.After RPKP,1 eye was enucleated.Visual acuity (VA) of 7 eyes (63.6％) was improved but gradually decreased in 3 eyes (27.2％).After RLKP,all 12 eyes were kept.VA of 8 eyes was improved,of which 3 eyes (25％) decreased gradually.Conclusions Infectious keratitis gave first place to the primary etiology of RPKP,while non-infectious keratitis is the first primary reason of RLKP.The direct etiology for both RPKP and RLKP is rejection of transplant,of which neovascularization and too large transplants may play an important role.After both of RPKP and RLKP,VA of most patients is improved but below finger counting.A part of patients presente a gradual decrease of VA after grafts.Therefore,repeat keratoplasty may be mainly for saving the eyeballs and improving the standard of living. Key words: Penetrating; Lamellar; Keratoplasty; Repeat; Retrospective review