Repeat penetrating keratoplasty: indications, graft survival, and visual outcome

Aim: To determine graft survival and visual outcome after repeat penetrating keratoplasty (PKP). Methods: Retrospective review of the medical records patients who underwent repeat PKP at the King Khaled Eye Specialist Hospital ( KKESH) between 1 January 1991 and 31 December 2002. Results: 243 repeat PKP performed in 210 eyes of 208 patients, who had also had initial PKP at KKESH, were included in the study. The mean follow up was 43 months (range 1-170). At the most recent examination, 114 (54.3%) grafts were clear. The overall survival rate was 98% at 1 year, 83% at 2 years, and 49% at 5 years. The best graft survival was in eyes with an original diagnosis of keratoconus (93.8%) and the worst was in eyes with Fuchs' dystrophy (23.1%). Overall, 29.6% of eyes achieved a final visual acuity greater than 20/200, while only 4.8% were 20/40 or better. The best visual prognosis was in eyes with an original diagnosis of stromal dystrophy and keratoconus. Conclusion: Although the prognosis for repeat PKP is poorer than that of initial PKP, reasonable outcomes can be obtained with repeat PKP with careful case selection.