Moderately Long-Term Safety and Efficacy of Repeat Penetrating Keratoplasty

Abstract

Purpose: To investigate the moderately long-term safety and efficacy of repeat penetrating keratoplasty (PK) for treatment of a failed PK graft.

Methods: Retrospective consecutive clinical case series. Of 992 consecutive cases that underwent PK at Baptist Eye Institute, Kyoto, Japan, between April 1998 and September 2013, 96 cases that underwent repeat PK with more than 3 years postoperatively follow-up were retrospectively reviewed. Surgical outcomes including donor graft survival rate, best spectacle-corrected visual acuity, endothelial cell density, and complications afeter repeat PK were assessed.

Results: At 1, 3, and 5 years after repeat PK, the donor graft survival rate was 91%, 75%, and 64%, respectively, and the mean endothelial cell density in those survived grafts was 1778, 1207, and 989 cells/mm, respectively. Best spectacle-corrected visual acuity over 20/200 and 20/40 was achieved in 71% and 27% of the patients, respectively, at 1 year postoperatively, in 59% and 31% of the patients, respectively, at 3 years postoperatively, and in 53% and 29% of the patients, respectively, at 5 years postoperatively. The most common complication for repeat PK was the need for additional glaucoma surgery [n = 11 patients (11.5%)]. Cox proportional hazard regression analyses revealed that previous glaucoma surgery and a rejection episode were high risk factors for graft failure in repeat PK [hazard ratio (HR) = 6.7; 95% confidence interval (CI), 2.1-21.2 and HR = 5.6; 95% CI, 1.8-18.0, respectively].

Conclusions: Repeat PK provided relatively safe and effective moderately long-term surgical outcomes.