Indications and outcome of repeat penetrating keratoplasty in India

M Vanathi,Rajesh Sinha,Namrata Sharma,Jeewan S Titiyal,Rasik B Vajpayee,Radhika Tandon

doi:10.1186/1471-2415-5-26

M Vanathi, Rajesh Sinha + Show 4 more

Open Access

https://doi.org/10.1186/1471-2415-5-26

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Journal: BMC ophthalmology	Publication Date: Nov 2, 2005
Citations: 58	License type: cc-by

Affiliation: All India Institute of Medical Sciences

Abstract

BackgroundRepeat penetrating keratoplasty is quite often required as there is high chance of failure of the primary graft particularly in the developing world. We planned a study to analyze the indications and outcome of repeat penetrating keratoplasty in a tertiary care centre in India.MethodsA retrospective analysis of all the patients who underwent repeat penetrating keratoplasty, between January 1999 and December 2001 was performed. The parameters evaluated were indication for the primary penetrating keratoplasty, causes of failure of the previous graft, and final visual outcome and clarity of the repeat corneal grafts.ResultsOf fifty-three eyes of 50 patients with repeat penetrating keratoplasty (three patients underwent bilateral corneal regrafts), 37 eyes had undergone one regraft each, 14 eyes two regrafts and two eyes had three regrafts. The follow-up of the patients ranged from one to three years. The most common primary etiologic diagnosis was vascularized corneal scars (66%), of which the scars related to infection were most common (68.5%). Twenty-eight regrafts (52.8%) remained clear at a mean follow-up of 1.54 ± 0.68 years, of which 25 were single regrafts (89.3%). The commonest cause of failure of regraft was infection to the corneal graft (recurrence of herpetic infection in 9 eyes and perforated graft ulcers in 3 eyes). Three (18.6%) of the 16 eyes with multiple corneal regrafts achieved a BCVA of 6/60. Overall, only five eyes (all with single regraft) achieved a BCVA of 6/18 or better at the end of follow-up.ConclusionGraft infection is the leading cause of failure of repeat keratoplasty in this part of the world. Prognosis for visual recovery and graft survival is worse in eyes undergoing multiple regrafts.

Highlights

Repeat penetrating keratoplasty is quite often required as there is high chance of failure of the primary graft in the developing world
Corneal graft failure constitutes a common indication for penetrating keratoplasty [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]
50 patients (73.5 %) (41 males and 9 females) had a regular follow-up with us of which, 3 patients had undergone bilateral corneal regrafts and these were included in the study (N = 53 eyes)

Summary

Introduction

Repeat penetrating keratoplasty is quite often required as there is high chance of failure of the primary graft in the developing world. We planned a study to analyze the indications and outcome of repeat penetrating keratoplasty in a tertiary care centre in India. Corneal graft failure constitutes a common indication for penetrating keratoplasty [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20]. A more recent study on the profile of repeat keratoplasty [27] identified vascularized corneal scar as the most common primary indication for corneal regrafting. The paucity of studies on repeat keratoplasty from (page number not for citation purposes)

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Conclusion