Etiology of repeat keratoplasty and risk factors for failure of corneal grafts
Journal of Otolaryngology and Ophthalmology of Shandong University
2020, 34 (3):
Objective This study aimed to analyze the causes of repeat keratoplasty and the risk factors for failure of corneal grafts. Methods This retrospective consecutive clinical case series enrolled all cases at Qingdao Eye Hospital, Shandong Eye Institute, between January 2010 and December 2018. Causes of repeat keratoplasty, primary disease before first keratoplasty, surgical methods of the first and repeat keratoplasty, and postoperative complications were analyzed. Statistical analysis was performed using SPSS 22.0 software. Results A total of 2,060 corneal transplants was performed in our hospital, of which 228(11.07%)were repeat keratoplasties. From 2010 to 2018, repeat keratoplasties were performed in 207 eyes of 204(137 male and 67 female)patients-189 eyes with first repeat keratoplasties, 15 eyes with second repeat keratoplasties, and 3 eyes with third repeat keratoplasties. The patient age was 11 to 81(mean: 49.93±14.32)years. The main reasons for repeat keratoplasty were graft ulcers(60 cases, 26.32%), corneal graft endothelial decompensation(58 cases, 25.44%), recurrence of primary disease(41 cases, 17.98%), and graft opacity(32 cases, 14.04%). First keratoplasty was most commonly performed for purulent keratitis(69 eyes, 33.33%), followed by herpes simplex keratitis(32 eyes, 15.46%), corneal burns(22 eyes, 10.63%), and corneal dystrophy and degeneration(21 eyes, 10.14%). Penetrating keratoplasty was performed in 202 cases(88.60%)for repeat corneal transplantation, anterior lamellar keratoplasty was performed in 26 cases(11.40%), and endothelial transplantation was performed in 0 cases. There was a correlation between repeat keratoplasty and previous keratoplasty(continuous correction χ2=43.365, P<0.01). Previous surgery affects the operation of repeat keratoplasties. Infectious keratopathy(P=0.005), graft diameter >8.75 mm(P=0.040), postoperative secondary glaucoma(P=0.027), and corneal graft rejection(P=0.047)were risk factors for penetrating keratoplasty graft failure. In multivariate Cox regression analysis, infectious keratopathy(P=0.011)and graft diameter >8.75 mm(P=0.016)were risk factors for anterior lamellar keratoplasty graft failure. Conclusion The most common cause of repeat keratoplasty was corneal graft ulcer, followed by corneal graft endothelial decompensation, and recurrence of the primary disease. Infectious keratitis was the most common primary disease before the first keratoplasty, followed by herpes simplex keratitis and corneal burns. Previous surgery affects the operation of repeat keratoplasties. Infectious keratopathy, graft diameter >8.75 mm, postoperative secondary glaucoma, and corneal graft rejection were risk factors for penetrating keratoplasty graft failure, whereas infectious keratopathy and graft diameter >8.75 mm were risk factors for anterior lamellar keratoplasty graft failure.
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