Purchase this article with an account.
Zane Anwar, Angie Wen; Outcomes of Patients with Multiple Penetrating Keratoplasties and Keratoprosthesis at a Tertiary-Referral Academic Teaching Service. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6201.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Repeat corneal grafts in patients who have had two or more previously failed penetrating keratoplasties (PK) have decreased survival times; one can consider a Boston Keratoprosthesis device (KPro) as an alternate procedure. In our retrospective, clinical study we compared repeat corneal graft patients who went on to have an additional PK with patients who underwent a KPro procedure, and examined survival/retention time, adverse events, and risk factors for failure.
Two groups of patients at our institution were identified: (1) those with history of three or more PKs (2) those who underwent KPro with history of prior PK. Charts were reviewed for demographics, best corrected visual acuity (BCVA), graft survival, KPro retention time, adverse events, and factors associated with survival. Binary logistic regression was used to identify statistical significance of risk factors.
The average age of our cohort was 52.7 years (7 months to 69 years) and 50% were male. Approximately 70% (9/13) of the regrafts were third PKs, 23% (3/13) were fourth PKs, and 7% (1/13) was a fifth PK. The average BCVA for the PK group was logMAR 1.136 (approximately 20/270) and maintained for an average of 14.6 months. For the KPro group average BCVA was logMAR 0.734 (approximately 20/100) and maintained for an average time of 27.3 months.The average survival time for all PK regrafts (3 or more) was 21.4 months and all were failed at the time of review. Seven of the nine KPro grafts (77%) had an adverse event at the time of the study: extrusion (1/7), endophthalmitis (2/7), progression of glaucoma (1/7), post-operative hypotony (1/7), retroprosthetic membrane (2/7). The average time to adverse event was 29.8 months.
Patients requiring additional surgery after multiple failed PKs are at high risk for a poor prognosis. In a tertiary-referral academic teaching institution, resources are limited and the decision for repeat surgery can be challenging. In our small cohort we attempt to characterize the graft/implant survivability and adverse event profile of such patients. Our patients undergoing multiple PKs had a longer graft survival time compared to the literature (21.4 vs 11.4 months). Patients with KPro after PK achieved better BCVA and longer maintenance of best vision, but had more adverse events.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
This PDF is available to Subscribers Only