PURPOSE: To determine factors influencing penetrating corneal graft survival in patients receiving repeat grafts in the same eye after a failed first graft for keratoconus. DESIGN: Large cohort study 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). CONCLUSIONS: 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. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
PURPOSE: To determine factors influencing penetrating corneal graft survival in patients receiving repeat grafts in the same eye after a failed first graft for keratoconus. DESIGN: Large cohort study 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). CONCLUSIONS: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. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Authors: Patrick J Chiam; Robert Cheeseman; Vivian W Ho; Vito Romano; Anshoo Choudhary; Mark Batterbury; Stephen B Kaye; Colin E Willoughby Journal: Graefes Arch Clin Exp Ophthalmol Date: 2017-03-17 Impact factor: 3.117