Long-term Functional and Anatomic Outcomes of Repeat Graft After Optically Failed Therapeutic Keratoplasty.

PURPOSE: To evaluate the functional and anatomic outcomes of repeat penetrating keratoplasty (PK) in optically failed therapeutic grafts.

DESIGN: Prospective interventional case series.

METHODS: All cases admitted at the apex tertiary care center for repeat keratoplasty following optically failed therapeutic PK were enrolled over a period of 1 year. Repeat optical PK was performed in all eyes. Primary outcome measures were postoperative graft clarity and visual acuity. Secondary outcome measures were complications including graft rejection, infections, failure, and secondary glaucoma. Follow-up examinations were undertaken on day 1; on day 7; at 1, 3, 6, and 12 months; and yearly thereafter.

RESULTS: Thirty-two eyes underwent repeat PK with mean follow-up of 18.4 ± 8.9 months. Clear grafts were observed in 63.14% of cases 1 year after regraft, and graft survival further decreased to 50% at last follow-up. Visual acuity ≥ 20/200 was achieved in 43.8% of cases, and no case had a visual acuity of ≥ 20/40. Multivariate Cox regression analysis analyzed risk factors for regraft survival, and observed a hazard ratio of 3.56 with size of initial therapeutic graft ≥ 8.75 mm, and 10.99 with deep vascularization in 1 or more quadrants. Graft survival (P = .004), visual acuity (P = .039), and rejection rates (P = .036) were significantly better in cases with initial therapeutic graft size < 8.75 mm. Secondary glaucoma was present in 59.4% (19/32) after regrafts.

CONCLUSION: Regraft after therapeutic PK is associated with suboptimal visual outcomes and long-term graft survival. Large size of initial therapeutic graft and deep vascularization adversely affect graft survival.