Indications and Surgical Techniques for Repeat Corneal Transplantation in Eastern China: A Twelve-Year Study.

Xichen Wan,Jianjiang Xu,Songjiao Zhao,Qihua Le,Wang Yao,Achim Langenbucher

doi:10.1155/2021/5514004

Abstract

Purpose To analyze the indications and surgical procedures for repeat keratoplasty in eastern China from 2008 to 2019. Methods This retrospective descriptive study included 418 eyes of 411 patients who underwent no less than 2 keratoplasties at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2008 to 2019. Medical charts were reviewed. The primary indications for repeat keratoplasty, the reasons for regrafting, and the surgical techniques used in the treatment were collected and analyzed. Results Among 418 eyes, 337 eyes (80.6%) had one repeat keratoplasty, and 81 eyes (19.4%) had multiple repeat keratoplasties (≥2 repeat keratoplasties). The median interval between the initial keratoplasty and the first repeat keratoplasty was 25 months, and that between two keratoplasties after the first repeat keratoplasty was 27.5 months. Infectious keratitis was the leading primary indication for single repeat keratoplasty (80 cases, 23.7%) and multiple repeat keratoplasties (19 cases, 23.5%). The second most common primary indication was bullous keratopathy for single repeat keratoplasty (49 eyes, 14.5%) and chemical injury for multiple repeat keratoplasties (14 eyes, 17.3%). The main reason for regrafting was allograft rejection (262 cases, 49.3%), followed by endothelial dysfunction (92 cases, 17.3%), and for vision improvement after tectonic keratoplasty (60 cases, 11.3%). Penetrating keratoplasty (PKP) was the major technique used in repeat keratoplasty (447 cases, 84.2%). However, Descemet stripping endothelial keratoplasty was more frequently used than PKP (72.4% vs. 27.6%, P < 0.001) in the treatment of failed endothelial keratoplasty. Conclusion Infectious keratitis was still the leading cause of repeat keratoplasty in eastern China. Although PKP remains the major technique of repeat keratoplasty, the application of customized lamellar keratoplasty has greatly expanded in the last decade. Cautious selection of indications, surgical techniques, and timing for surgery is crucial for a good prognosis after repeat keratoplasty.

Highlights

With the widespread use of keratoplasty in the treatment of corneal blindness and increasing life expectancy, regraft has been one of the most common indications for keratoplasty in recent decades [1,2,3,4,5]
It has been reported that primary indications have an important impact on the prognosis of repeat keratoplasty
E leading primary indication greatly varies among different countries [4, 7,8,9], and it was reported to be pseudophakic bullous keratopathy in developed countries [4, 6] and vascularized corneal scarring in developing countries [7]

Summary

Introduction

With the widespread use of keratoplasty in the treatment of corneal blindness and increasing life expectancy, regraft has been one of the most common indications for keratoplasty in recent decades [1,2,3,4,5]. It has been reported that primary indications have an important impact on the prognosis of repeat keratoplasty. Penetrating keratoplasty (PKP) remains the main surgical technique of repeat keratoplasty worldwide [3]. With the development of various lamellar keratoplasties and endothelial keratoplasties in recent decades, its use has gradually expanded in repeat keratoplasty. [12,13,14] Renovations of surgical techniques provide more customized options in repeat keratoplasty and to a certain With the development of various lamellar keratoplasties and endothelial keratoplasties in recent decades, its use has gradually expanded in repeat keratoplasty. [12,13,14] Renovations of surgical techniques provide more customized options in repeat keratoplasty and to a certain

Methods

Results

Conclusion