Repeat penetrating keratoplasty: indications and prognosis, 1995-2005

To evaluate the data of penetrating keratoplasty over a 10-year period and to compare indications and outcomes of eyes undergoing single graft with those of eyes requiring regrafting.

A total of 652 eyes of 613 patients required single graft (Group I). Sixty-one regrafts were performed on 53 eyes (Group II). The mean follow-up time was 23.4+/-21.3 months (range 6-132 months). The results were evaluated for the following criteria: primary indications, allograft reactions, graft clarity, final postoperative visual acuity, and complications leading to reduction in vision.

The most common indication was keratoconus (228 eyes; 35.0%) in Group I, and vascularized corneal scar (12 eyes; 22.6%) in Group II. Allograft reactions occurred in 96 eyes (14.7%) in Group I, and 17 eyes (32.0%) in Group II (p=0.001). At the end of the study period, 76.4% of patients in Group I had entirely clear grafts, whereas 45.3% of patients in Group II had entirely clear grafts (p=0.000). The main causes of corneal graft failure were irreversible allograft reaction, endothelial failure, and graft infection, which were all seen in higher percentage in the regraft group. A best-corrected visual acuity of 20/100 or better was achieved in 377 eyes (57.8%) in Group I and 11 eyes (20.7%) in Group II (p=0.000).

The complications of repeated surgery may reduce final graft clarity and visual acuity; the disease process necessitating regrafting may carry a poorer prognosis for sight.