Purpose To compare graft survival and visual outcomes for endothelial keratoplasty (EK) after a first penetrating keratoplasty (PK), with outcomes of repeat PK after a first PK.
Methods 400 eyes with a second graft (65 EKs, 335 PKs) performed after failure of a primary PK were identified through the Australian Corneal Graft Registry, a national prospectively followed cohort. Grafts were performed after January 2008 (follow-up of the second graft extending to 6.75 years maximum). Kaplan–Meier graft survival plots were constructed and Cox proportional hazards regression was used to identify independent risk factors for graft failure. Best-corrected Snellen visual acuity (BCVA) at last follow-up was compared with pregraft acuity.
Results Poor Kaplan–Meier graft survival was observed for PK-EK compared with PK-PK (log-rank=29.66, p<0.001). Variables retained in multivariate analysis as significantly influencing survival of the second graft included graft type (PK-EK or PK-PK, p<0.001), length of survival of the previous PK (global p=0.011), graft era (global p=0.018), occurrence of rejection in the second graft (p=0.005) and a history of raised intraocular pressure at any time (p=0.048), but not indication for the first graft. BCVA improved in the majority of surviving grafts and attainment of 6/12 vision was similar for both PK-EK and PK-PK groups.
Conclusions Our registry findings suggest that repeat PK may deliver a better outcome in terms of graft survival than EK after a failed PK that was performed initially for keratoconus or pseudophakic bullous keratopathy. For surviving grafts, visual outcomes appeared equivalent across groups.
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Contributors MCK: acquisition of data, analysis and interpretation of data, drafting of manuscript. RAG: acquisition of data. RADM: revision of manuscript. DJC: critical revision of the manuscript on multiple occasions. KAW: study concept and design, interpretation of data, drafting and critical revision of manuscript. Contributors to the ACGR: voluntary provision of data.
Funding Supported by the Australian Government Organ and Tissue Donation Authority (DonateLife). KAW is supported by the National Health and Medical Research Council of Australia.
Competing interests None declared.
Ethics approval Approved by the Institutional Clinical Ethics Review Committee.
Provenance and peer review Not commissioned; externally peer reviewed.