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