Abstract
Purpose :
Repeat keratoplasty constitutes a growing major indication for corneal grafting although generally associated with poorer visual outcomes and increased risk of postoperative complications compared to the first graft. We describe findings from a retrospective surgical case series on indications, visual outcomes, and complications for repeat keratoplasty performed by residents or fellows under attending supervision at Los Angeles County Hospital.
Methods :
Eye that underwent repeat corneal grafting at Los Angeles County (LAC) Hospital from January 1, 2015 to September 1, 2019 were identified by an electronic medical record (EMR) query using CPT codes for endothelial keratoplasty (65756), penetrating keratoplasty (PK; 65730, 65750, 65755), and unlisted surgical procedure on anterior segment (66999) (n=137) to determine surgical indications and outcomes, including intraoperative and postoperative complications, ocular comorbidities, graft clarity, and final best corrected visual acuity (BCVA). Exclusion criteria include follow-up <6 months. BCVA at most recent visit was compared to preoperative BCVA with Wilcoxon signed rank test (p=0.05).
Results :
Of the eyes identified through the EMR query, 24 underwent repeat corneal grafting including PK (n=19), Descemet stripping automated endothelial keratoplasty (DSAEK, n=2), and DSAEK under previous failed PK (3). Median length of follow-up was 20.5 months (IQR 10.8, 37.9). Indications for repeat keratoplasty were primary graft failure (16), graft rejection (3), perforated cornea (3), endothelial decompensation (1), and retrocorneal membrane formation (1). Eleven (46%) had glaucoma hardware in the anterior chamber and 17 had ocular comorbidities such as advanced glaucoma (11) which potentially limited final BCVA. Median preoperative BCVA was 2.3 logMAR (1.9, 2.3) in this cohort. There was a significant improvement of -0.41 logMAR in median BCVA at most recent follow-up after repeat keratoplasty (p=0.009). Postoperative complications included infectious ulcer (2), canaliculitis (1), endophthalmitis (1), steroid response (1), and graft non-adherence with poorly positioned ACIOL (1). Ten grafts failed within the study period.
Conclusions :
Repeat keratoplasty performed by supervised trainees demonstrated statistically significant improvement in best-corrected visual acuity and may be a viable option to treat visual impairment following graft failure or rejection.
This is a 2020 ARVO Annual Meeting abstract.