Elsevier

Ophthalmology

Volume 107, Issue 4, April 2000, Pages 719-724
Ophthalmology

Original Articles
Indications for and outcomes of repeat penetrating keratoplasty, 1989–1995

https://doi.org/10.1016/S0161-6420(00)00003-8Get rights and content

Abstract

Objective

To evaluate the indications for and outcomes of repeat penetrating keratoplasty over a 7-year period and compare them to a similar study over the prior 6-year period at the same institution.

Design

Retrospective noncomparative case series.

Participants

Two hundred twenty-three consecutive repeat corneal transplants performed by one of five corneal surgeons between 1989 and 1995 were studied.

Main outcome measures

Reasons for primary and regraft failure, indications for the initial corneal graft, graft clarity, and best-corrected visual acuity were measured on each patient.

Results

Between 1989 and 1995, 16% (271 of 1689) of transplants performed by our cornea group were regrafts compared with 9% (165 of 1860) in the period from 1983 to 1988 (P < 0.01).1 The most common indications for penetrating keratoplasty before regraft were pseudophakic bullous keratopathy (27%, 61 of 223), failed graft (20%, 44 of 223), Fuchs’ dystrophy (11%, 24 of 223), aphakic bullous keratopathy (9%, 21 of 223), keratoconus (8%, 17 of 223), and herpes simplex keratitis (6%, 14 of 223). Compared with the prior study period of 1983 to 1988, an increase was revealed in the incidence of failed graft (11% to 20%, P = 0.03), and a decrease was revealed in the incidence of aphakic bullous keratopathy (19% to 9%, P = 0.01). Of the 223 regrafts, 55 (25%) failed during the study period (range, 1 month to 7.5 years; mean 2.1 years). Eleven percent (6 of 55) of regraft failures occurred within 6 months, and 55% (30 of 55) failed within 18 months. Of the 150 regrafts with 2 years follow-up (mean, 3.9 years), 111 (74%) had clear grafts. A best-corrected visual acuity of 20/20 to 20/40 was achieved in 41% (46 of 111), 20/50 to 20/100 in 32% (36 of 111), 20/200 to 20/400 in 21% (23 of 111), and counting fingers to no light perception in 5% (6 of 111).

Conclusions

Failed grafts are increasing as an indication for penetrating keratoplasty. Graft clarity and visual acuity results continue to be very good, supporting the use of repeat corneal transplantation.

Section snippets

Materials and methods

We reviewed the hospital and office charts of repeat penetrating keratoplasties performed by any one of five corneal surgeons at Wills Eye Hospital between January 1, 1989, and December 31, 1995. Information that was reviewed included patient gender and age, dates of previous and most recent penetrating keratoplasties, clinical diagnosis before the initial graft, reason for graft failure, total number of grafts performed, final visual acuity, graft clarity, and reason for regraft failure, if

Results

Compared with the previous study period of 1983 to 1988, the total number and percentage of regrafts for all surgeons at Wills Eye Hospital for the study period of 1989 to 1995 have increased from 233 (of 2299, or 10%) to 434 (of 2442, or 18%) (P < 0.01).2, 3 For our subspecialty cornea group, the total number and percentage of regrafts reveals a similar increase from 165 (of 1860, or 9%) to 271 (of 1689, or 16%) (P < 0.01).1 Between 1989 and 1995, all of the 1689 corneal transplants were

Discussion

Since the report by Rapuano and associates in 1990, there have been no studies providing updated results on the indications for and outcomes of repeat penetrating keratoplasty. Several studies, however, have been published in the past few years investigating the indications for penetrating keratoplasty. Recently, Lois et al2 reported data on the indications for penetrating keratoplasty from the years 1989 to 1995 at our institution as an update to the study published by Brady et al in 1989.3 We

References (13)

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