Indications and Surgical Techniques for Repeat Corneal Transplantation in Eastern China: A Twelve-Year Study

Abstract

Purpose. To analyze the indications and surgical procedures for repeat keratoplasty in eastern China from 2008 to 2019. Methods. This retrospective descriptive study included 418 eyes of 411 patients who underwent no less than 2 keratoplasties at the Eye, Ear, Nose and Throat Hospital of Fudan University from 2008 to 2019. Medical charts were reviewed. The primary indications for repeat keratoplasty, the reasons for regrafting, and the surgical techniques used in the treatment were collected and analyzed. Results. Among 418 eyes, 337 eyes (80.6%) had one repeat keratoplasty, and 81 eyes (19.4%) had multiple repeat keratoplasties (≥2 repeat keratoplasties). The median interval between the initial keratoplasty and the first repeat keratoplasty was 25 months, and that between two keratoplasties after the first repeat keratoplasty was 27.5 months. Infectious keratitis was the leading primary indication for single repeat keratoplasty (80 cases, 23.7%) and multiple repeat keratoplasties (19 cases, 23.5%). The second most common primary indication was bullous keratopathy for single repeat keratoplasty (49 eyes, 14.5%) and chemical injury for multiple repeat keratoplasties (14 eyes, 17.3%). The main reason for regrafting was allograft rejection (262 cases, 49.3%), followed by endothelial dysfunction (92 cases, 17.3%), and for vision improvement after tectonic keratoplasty (60 cases, 11.3%). Penetrating keratoplasty (PKP) was the major technique used in repeat keratoplasty (447 cases, 84.2%). However, Descemet stripping endothelial keratoplasty was more frequently used than PKP (72.4% vs. 27.6%, P < 0.001 ) in the treatment of failed endothelial keratoplasty. Conclusion. Infectious keratitis was still the leading cause of repeat keratoplasty in eastern China. Although PKP remains the major technique of repeat keratoplasty, the application of customized lamellar keratoplasty has greatly expanded in the last decade. Cautious selection of indications, surgical techniques, and timing for surgery is crucial for a good prognosis after repeat keratoplasty.

Repeat corneal transplantation in Southern China: Indications, surgical technique, outcomes, and risk factors for repeat keratoplasty failure

“…[ 17 ] The growing trend of EK surgery was also reported by an ophthalmology center in eastern China. [ 16 ] Our results show that EK has become an alternative to PK after failed PK surgery in China.…”

Combined versus sequential penetrating keratoplasty and cataract surgery for herpes simplex keratitis: a retrospective study

“…Corneal diseases requiring PK are usually accompanied with cataract. Especially, progressed or mature cataract with a risk of secondary glaucoma or uveitis requires surgical removal (1). Despite combined or sequential PK and cataract surgery is recognized as effective and well-established surgical treatment for corneal diseases accompanied with cataract, cataract surgery performed in patients with preexisting corneal diseases, still has a potential risk to leading to bad outcomes for visual acuity and increasing the risk of complications (2).…”