Clinical Outcome of Repeat Penetrating Keratoplasty

Purpose: To compare the clinical outcome of regrafts with first grafts. Methods: Two-year outcome data were obtained from the Swedish Cornea Transplant Register for patients undergoing penetrating keratoplasty between 2001 and 2008. Only data from the 3 centers with follow-up return rates >75% were included. The survival and visual outcome of regrafts with the original diagnoses of keratoconus, Fuchs endothelial dystrophy (FED), or bullous keratopathy (BK) were compared with first grafts for the same diagnoses by univariate and logistic regression methods. Results: For keratoconus, the failure rate increased 3-fold in regrafts compared with first grafts (ie, 17% vs. 6%; P = 0.002) and doubled in FED regrafts (33% vs. 15%; P = 0.001). In BK, the failure rate was already high in first grafts, and the increase in failure of regrafts was minimal (P = 0.9). Visual acuity was also worse in regrafts compared with first grafts, mainly in the keratoconus and FED patients. In the keratoconus group, visual acuity with preferred correction was ≥0.5 in 69% of first grafts compared with only 55% in regrafts (P = 001). In FED, 52% of first grafts but only 19% of regrafts achieved visual acuity ≥0.5 (P = 0.001). The visual outcome of regrafts in BK was poor but little different from first grafts where fewer than 20% achieved visual acuity ≥0.5. Conclusions: This analysis confirmed the poorer survival of regrafts where the original indication was keratoconus or FED. In addition, visual outcome was also worse than in the first grafts. However, the outcomes of regrafts in BK were similar to first grafts.