Outcome of repeat penetrating keratoplasty and risk factors for graft failure

Abstract

Aretrospective, consecutive, noncomparative series of 116 patients who underwent repeat penetrating keratoplasty (PK) with a cohort series of 696 patients who underwent primary PK were studied with respect to patient characteristics, graft survival rates, and risk factors for graft failure. All cases were performed by one surgeon over a 7.5-year period. There was no difference between the two groups with respect to the original indication for surgery. Compared with patients who underwent primary PK, regraft patients were 5 years older, had a higher rate of peripheral anterior synechiae, were more likely to require intraocular pressure-lowering medications prior to surgery, were more likely to develop postoperative corneal neovascularization, were less likely to be phakic, and were more likely to undergo PK in conjunction with a lens procedure. The overall graft survival rate for repeat PK was 63.9% at 2 years and 45.6% at 5 years postoperatively. The primary PK population had significantly higher 2- and 5-year graft survival rates of 78.8% and 64.6%, respectively (P < .001). In a multivariate analysis, the original diagnosis leading to corneal transplantation, the presence of preoperative peripheral anterior synechiae, intraoperative anterior vitrectomy and postoperative corneal neovascularization were identified as risk factors for graft failure in patients undergoing a regraft. The difference in graft survival rates between primary and repeat PK can be partially explained by the higher rate of the latter three risk factors.—Michael D. Wagoner