J Korean Ophthalmol Soc.  2011 Dec;52(12):1399-1404. 10.3341/jkos.2011.52.12.1399.

Long-Term Results after Three or More Penetrating Keratoplasties and Risk Factors for Graft Failure

• Jang JY
• Woo JM
• Yoon KC

• KMID: 2215141
• DOI: http://doi.org/10.3341/jkos.2011.52.12.1399

Abstract

PURPOSE
To evaluate the primary indications, surgical outcomes, causes and risk factors for graft failure in patients with three or more penetrating keratoplasty (PKP) surgeries.
METHODS
We retrospectively analyzed indications for the initial corneal graft, survival periods, causes and risk factors for failure in 25 patients (26 eyes) who had undergone three or more PKP with minimum follow-up periods of nine months.
RESULTS
The most common primary indications were herpes simplex keratitis (26.9%), followed by fungal keratitis (19.2%) and bacterial keratitis (11.5%). The average survival period of graft in three or more PKP was 12.9 +/- 9.1 months. As the frequency of PKP increased, the survival period became shorter; the survival period was the longest in pseudophakic bullous keratopathy and the shortest in herpes simplex keratitis. The most common cause of graft failure was allograft rejection (82.8%), and the risk factors for graft failure were short interval between penetrating keratoplasties and corneal neovascularization.
CONCLUSIONS
In three or more PKP, as the frequency of PKP increases, the survival period becomes shorter. Short interval between keratoplasties and cornel neovascularization were risk factors for graft failure; this results must be considered before surgery.

Keyword

Graft Failure; Risk Factor; Three or More Penetrating Keratoplasties

MeSH Terms

Corneal Transplantation
Follow-Up Studies
Humans
Keratitis
Keratitis, Herpetic
Keratoplasty, Penetrating
Methylmethacrylates
Polystyrenes
Rejection (Psychology)
Retrospective Studies
Risk Factors
Transplantation, Homologous
Transplants
Methylmethacrylates
Polystyrenes

Figure

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  Figure 1. The indications of the primary penetrating keratoplasty in patients undergoing three or more penetrating keratoplasties. HSK = herpes simplex keratitis, PBK = pseudophakic bullous keratopathy, ABK = aphakic Bullous keratopathy, SJS = Stevens-Jonson syndrome.

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  Figure 2. Mean survival period of three or more penetrating keratoplasties. PKP = penetrating keratoplasty.

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  Figure 3. Kaplan-Meire survival curve of three or more penetrating keratoplasties.

Reference

References

1. Choi SH, Lee YW, Kim HM, et al. Epidemiologic Studies of Keratoplsty in Korea. J Korean Ophthalmol Soc. 2006; 47:538–47.

2. Boisjoly HM, Tourigny R, Bazin R, et al. Risk factors of corneal graft failure. Ophthalmology. 1993; 100:1728–35.

3. Kim EC, Kim MS. Graft rejection in penetrating keratoplasty. J Korean Ophthalmol Soc. 2003; 44:289–95.

4. Weisbrod DJ, Sit M, Naor J, Slomovic AR. Outcomes of repeat penetrating keratoplasty and risk factors for graft failure. Cornea. 2003; 22:429–34.

5. Yildiz EH, Hoskins E, Fram N, et al. Third or greater penetrating keratoplasties: indications, survival, and visual outcomes. Cornea. 2010; 29:254–9.

6. Tchah HW, Ha DW, Kim CK, et al. Penetrating keratoplasty results in 275 cases. J Korean Ophthalmol Soc. 2001; 42:20–9.

7. Yoon KC, Park YK, Park YG. Surgical results of repeat penetrating keratoplasty and risk factors for graft failure. J Korean Ophthalmol Soc. 2004; 45:1827–32.

8. Djalilian AR, Nussenblatt RB, Holland EJ. Immnunosuppressive therapy in ocular surface transplantation. Holland EJ, Mannis MJ, editors. Ocular Surface Disease Medical and Surgical Management. 1st ed.New York: Springer;2002. 1:chap. 22.

9. Halberstadt M, Machens M, Gahlenbek KA, et al. The outcome of corneal grafting in patients with stromal keratitis of herpetic and non-herpetic origin. Br J Ophthalmol. 2002; 86:646–52.

10. Robinson CH. Indications, complications and prognosis for repeat penetrating keratoplasty. Ophthalmic Surg. 1979; 10:27–34.

11. Rapuano CJ, Cohen EJ, Brady SE, et al. Indications for and outcomes of repeat penetrating keratoplasty. Am J Ophthalmol. 1990; 15:689–95.

12. Maeno A, Naor J, Lee HM, et al. Three decades of corneal transplantation: indications and patient characteristics. Cornea. 2000; 19:7–11.

13. MacEwen CJ, Khan ZU, Anderson E, MacEwen CG. Corneal re-graft: indications and outcome. Ophthalmic Surg. 1988; 19:706–12.

14. Patel NP, Kim T, Rapuano CJ, et al. Indications for and outcomes of repeat penetrating keratoplasty, 1989-1995. Ophthalmology. 2000; 107:719–24.

15. Vanathi M, Sharma N, Sinha R, et al. Indications and outcome of repeat penetrating keratoplasty in india. BMC Ophthalmol. 2005; 5:26.

16. Al-Mezaine H, Wagoner MD, King Khaled Eye Specialist Hospital Cornea Transplant Study Group. Repeat penetrating keratoplasty: indication, graft survival, and visual outcome. Br J Ophthalmol. 2006; 90:324–7.

17. Bersudsky V, Blum-Hareuveni T, Rehany U, Rumelt S. The profile of repeated corneal transplantation. Ophthalmology. 2001; 108:461–9.