Corneal regrafting after endothelial keratoplasty

To determine the incidence of corneal regrafting after endothelial keratoplasty (EK) and to explore the possible reasons for repeat EK and subsequent penetrating keratoplasty (PK).

This retrospective cohort study examined the occurrence of corneal regrafts among 803 eyes of 751 patients who underwent initial EK from January 2004 through February 2009 using donor corneas distributed by a single eye bank. Regression models and life tables evaluated the effects of donor corneal characteristics on the probability of a regraft.

Corneal regrafting after EK occurred in 119 eyes (15%), including 68 with repeat EK and 51 with subsequent PK. Ninety-five regrafts (80%) occurred within 1 year of EK, with 39 (33%) during the first postoperative month. Three years after EK, the cumulative probability of repeat EK was 11% and was 9% for subsequent PK. The secular trend in regrafting indicated an average 4% decline per year from 2005 to 2008. The odds of regrafting occurred less often (P = 0.004) with 202 eye bank-processed corneas than with 601 surgeon-prepared tissues. The cumulative probability of repeat EK was increased if donor corneas were maintained in preservation medium for more than 7 days (P = 0.02). Older donor age, death-to-preservation interval, or lower endothelial density was not significantly associated with repeat keratoplasty.

Regrafting after EK is becoming less common, possibly because of surgical experience and technical innovations such as eye bank processing of precut tissues. Timely screening and distribution of donor corneas may foster graft survival.