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E. H. Yildiz, Jr., E. J. Cohen, Sr., E. Hoskins, Jr., N. Fram, Jr., C. J. Rapuano, Sr., K. M. Hammersmith, Sr., P. R. Laibson, Sr.; Third or Greater Penetrating Keratoplasties: Indications, Graft Survival and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2009;50(13):615.
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© ARVO (1962-2015); The Authors (2016-present)
To report the indications, graft survival, the risk factors for graft failure, and visual outcomes of third or more repeat penetrating keratoplasties (PKP).
Five years of Wills Eye Institute Cornea Service charts (2000-2005) were retrospectively reviewed to identify all patients who had undergone three or more PKP. Graft survival rates by initial diagnosis and risk factors for graft failure were analyzed.
45 patients who had multiple repeat PKP’s were identified. Total number of PKP’s performed was 152 including 45 third PKP’s, 11 fourth, 3 fifth, 2 sixth, and 1 seventh. The most common indication for initial PKP was PBK in 18/45 (41%) patients, followed by Fuchs’ dystrophy (7/45 patients (16%)) and stromal dystrophies (5/45 patients (11%)). 47% of third grafts (24/45) and 27% of fourth grafts (3/11) were clear at last follow-up visit. 1,2 and 5 year graft survival rates were 89%, 78%, and 53% for the third grafts, and 73%, 73%, and 64% for the fourth grafts. The median survival time for third grafts in PBK, Fuch’s dystrophy, stromal dystrophy and ICE groups were 3.0, 12.8, 2.0, and 2.3 years, respectively (p=0.46). Risk factor analysis on the third grafts showed that preoperative glaucoma procedures and neovascularization are risk factors for graft failure(p=0.04 and 0.02, respectively).
Over 50% of third and fourth grafts were clear at 5 years postoperatively. Absence of history of glaucoma surgery and/or corneal neovascularization is associated with better outcomes of multiple PKP’s.
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