April 2009
Volume 50, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2009
Third or Greater Penetrating Keratoplasties: Indications, Graft Survival and Visual Outcomes
Author Affiliations & Notes
  • E. H. Yildiz, Jr.
    Ophthalmology, Wills Eye Institute, Philadelphia, Pennsylvania
  • E. J. Cohen, Sr.
    Ophthalmology, Wills Eye Institute, Philadelphia, Pennsylvania
  • E. Hoskins, Jr.
    Ophthalmology, Wills Eye Institute, Philadelphia, Pennsylvania
  • N. Fram, Jr.
    Ophthalmology, Wills Eye Institute, Philadelphia, Pennsylvania
  • C. J. Rapuano, Sr.
    Ophthalmology, Wills Eye Institute, Philadelphia, Pennsylvania
  • K. M. Hammersmith, Sr.
    Ophthalmology, Wills Eye Institute, Philadelphia, Pennsylvania
  • P. R. Laibson, Sr.
    Ophthalmology, Wills Eye Institute, Philadelphia, Pennsylvania
  • Footnotes
    Commercial Relationships  E.H. Yildiz, Jr., None; E.J. Cohen, Sr., None; E. Hoskins, Jr., None; N. Fram, Jr., None; C.J. Rapuano, Sr., None; K.M. Hammersmith, Sr., None; P.R. Laibson, Sr., None.
  • Footnotes
    Support  None.
Investigative Ophthalmology & Visual Science April 2009, Vol.50, 615. doi:
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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)

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Abstract

Purpose: : To report the indications, graft survival, the risk factors for graft failure, and visual outcomes of third or more repeat penetrating keratoplasties (PKP).

Methods: : 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.

Results: : 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).

Conclusions: : 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.

Keywords: cornea: clinical science • transplantation 
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