Repeat penetrating corneal transplantation in patients with keratoconus
Coster, Douglas John
Williams, Keryn Anne
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To determine factors influencing penetrating corneal graft survival in patients receiving repeat grafts in the same eye after a failed first graft for keratoconus, a large cohort study was conducted from a national register of corneal grafts, in which data were recorded prospectively and analyzed retrospectively. Follow-up extended to 23 years. Participants Follow-up was available for 229 regrafts performed in 177 eyes of 173 patients. Regrafts were performed more than once in 16 eyes. Methods Corneal graft survival was analyzed using Kaplan–Meier survival plots and Cox proportional hazards regression, clustered by patient. Main Outcome Measures Graft survival. Results Graft survival was significantly worse (P<0.001) for second (n = 176) and third or greater grafts (n = 20), compared with first grafts for keratoconus (n = 4871). Kaplan–Meier survivals at 1, 5, and 15 years postgrafting were 88%, 69%, and 46% for second grafts, and 65%, 49%, and 33% for third and subsequent grafts, respectively (P<0.001). Risk factors associated with graft failure of repeat grafts in multivariate analysis were the geographic location of surgery (“center”; P = 0.04), failure of the previous graft within 10 years of surgery (P = 0.02), recipient age at graft ≥60 years (P = 0.04), occurrence of rejection episodes (P = 0.007), and corneal neovascularization postoperatively (P = 0.007). Repeat corneal grafts in eyes originally grafted for keratoconus showed better survival when the previous graft had survived ≥10 years, surgery was performed at a favorable location, the recipient was <60 years old at grafting, and graft rejection and neovascularization were circumvented.