Indications for and outcomes of repeat penetrating keratoplasty, 1989-1995

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). 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.