Clinical Research Of Repeat Keratoplasty

ObjectiveTo investigate the major etiologies and outcomes of repeat penetrating keratoplasty (RPKP) and repeat lamellar keratoplasty (RLKP).MethodsRetrospective review of23eyes from19patients undergoing RPKP and RLKP from January1,2009, through December31,2011, in Department of Ophthalmology of First Affiliated Hospital of Chongqing Medical University, to determine the major etiologies, intervals between2grafts, influencing factors and outcomes for RPKP and RLKPResults1.11eyes from11patients were involved in RPKP. Primary etiologies for RPKP were infectious keratitis (5cases,45.5%), leucoma of cornea (3cases,27.3%), corneal degeneration (2cases,18.2%) as well as chemical burn (1case,9.1%). The direct causes of RPKP were corneal rejection (6cases,54.5%), perforation and ulcer of transplant (2cases,18.2%), CCAD (2cases,18.2%) and recurrence of primary disease (1case,9.1%).2.12eyes from10patients were involved in RLKP. Primary etiologies for RPKP were non-infectious keratitis (5eyes,41.7%), infectious keratitis (3eyes,25%), chemical burn (2eyes,16.7%), corneal degeneration and dystrophy, as well as thermal burn (1eye,8.3%). The direct causes of RLKP were corneal rejection (8eyes,66.7%), recurrence of primary disease, leucoma of cornea (3eyes,25%), and CCAD (1eye,8.3%).3. Intervals between2PKP were from0.5to60months, with an average of (23.8±20.9) months, those between2LKP were from3to120months, with an average of (23.5±31.6) months.All patients were followed form9to32months, with an average of (22.0±7.9) months. After RPKP,1eye was enucleated. Visual acuity (VA) of7eyes (63.6%) was improved but gradually decreased in3eyes (27.2%). After RLKP, all12eyes were kept. VA of8eyes were improved, of which3eyes (25%) decreased gradually.Conclusion1. Infectious keratitis gave first place to the primary etiology of RPKP, while non-infectious keratitis was the first primary reason of RLKP.2. The direct etiology for both RPKP and RLKP was rejection of transplant, of which neovascularization and too large transplants may play an important role.3. After both of RPKP and RLKP, VA of most patients were improved but below finger counting. A part of patients presented a gradual decrease of VA after grafts. Therefore, repeat keratoplasty may be mainly for saving the eyeballs, but not for the improvement of VA.