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Jang, Woo, and Yoon: Long-Term Results after Three or More Penetrating Keratoplasties and Risk Factors for Graft Failure
Original Article

J Korean Ophthalmol Soc 2011;52(12):1399-1404.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.12.1399

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

Jae Yong Jang, MD1, Je Moon Woo, MD2, Kyung Chul Yoon, MD, PhD1

1Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

2Department of Ophthalmology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

Address reprint requests to Kyung Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Hospital #8 Hak-dong, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6741, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 11 January 201123 March 2011       Accepted 30 September 2011

Copyright © 2011 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 followup 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.

Keywords: Graft Failure, Risk Factor, Three or More Penetrating Keratoplasties

References

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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.
jkos-52-1399f1.tif
Figure 2.
Mean survival period of three or more penetrating keratoplasties. PKP = penetrating keratoplasty.
jkos-52-1399f2.tif
Figure 3.
Kaplan-Meire survival curve of three or more penetrating keratoplasties.
jkos-52-1399f3.tif
Table 1.
Causes of graft failure in three or more penetrating keratoplasties
Causes No. of grafts (%)
Allograft rejection 24 (82.8)
Endothelial failure 3 (10.4)
Postoperative glaucoma 1 (3.4)
Recurrence of host disease 1 (3.4)
Total 29 (100)
Table 2.
Univariate analysis of risk factors for graft failure in patients with three or more penetrating keratoplasties
Factors   No. of grafts (%)
 p-value
  Success Failure
Interval between penetrating keratoplasties <1 year 2 (20.0) 10 (62.5) 0.01
  1 to 3 years 4 (40.0) 5 (31.3)  
  >3 years 4 (40.0) 1 (6.2)  
Original etiology Favorable 2 (20.0) 0 (0) 0.07
  Unfavorable 8 (80.0) 16 (100)  
Chronic inflammation Yes 4 (40.0) 12 (75.0) 0.08
  No 6 (60.0) 4 (25.0)  
Corneal neovascularization Yes 4 (40.0) 14 (87.5) 0.01
  No 6 (60.0) 2 (12.5)  
Grade of neovascularization (mean ± SD)   1.80 ± 1.03 2.25 ± 0.68 0.21
Peripheral anterior synechiae Yes 2 (20.0) 10 (62.5) 0.04
  No 8 (80.0) 6 (37.5)  
Use of glaucoma eye drops Yes 3 (30.0) 12 (75.0) 0.02
  No 7 (70.0) 4 (25.0)  
Lens status Aphakia 2 (20.0) 4 (25.0) 0.67
  Pseudophakia 4 (40.0) 7 (43.7)  
  Phakia 4 (40.0) 5 (31.3)  
Graft size <7.5 mm 3 (30.0) 5 (31.3) 0.86
  7.5 to 8.0 mm 4 (40.0) 5 (31.3)  
  >8.0 mm 3 (30.0) 6 (37.4)  
Anterior vitrectomy Yes 4 (40.0) 13 (81.2) 0.03
  No 6 (60.0) 3 (18.8)  
Suture methods Interrupted 7 (70.0) 9 (56.3) 0.50
  Mixed 3 (30.0) 7 (43.7)  
Use periods of postoperative systemic steroid <3 months 6 (60.0) 13 (81.3) 0.25
  ≥3 months 4 (40.0) 3 (18.7)  
Table 3.
Multivariate analysis of risk factors for graft failure in patients with three or more penetrating keratoplasties
Risk factor p-value Relative risk 95% CI
Lower Upper
Interval between penetrating keratoplaties < 1 year 0.01 7.88 1.41 25.55
Corneal neovascularization 0.03 4.55 1.13 13.31
Peripheral anterior synechia 0.29 1.82 0.71 4.7
Use of glaucoma eye drops 0.12 1.99 2.33 5.13
Anterior vitrectomy 0.16 1.95 1.56 5.12

CI = confidence interval.

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