Author version made available in accordance with publisher copyright policy.Purpose To compare graft survival and visual
outcomes for endothelial keratoplasty (EK) after a first
penetrating keratoplasty (PK), with outcomes of repeat
PK after a first PK.
Methods 400 eyes with a second graft (65 EKs, 335
PKs) performed after failure of a primary PK were
identified through the Australian Corneal Graft Registry,
a national prospectively followed cohort. Grafts were
performed after January 2008 (follow-up of the second
graft extending to 6.75 years maximum). Kaplan–Meier
graft survival plots were constructed and Cox
proportional hazards regression was used to identify
independent risk factors for graft failure. Best-corrected
Snellen visual acuity (BCVA) at last follow-up was
compared with pregraft acuity.
Results Poor Kaplan–Meier graft survival was observed
for PK-EK compared with PK-PK (log-rank=29.66,
p<0.001). Variables retained in multivariate analysis as
significantly influencing survival of the second graft
included graft type (PK-EK or PK-PK, p<0.001), length
of survival of the previous PK (global p=0.011), graft
era (global p=0.018), occurrence of rejection in the
second graft (p=0.005) and a history of raised
intraocular pressure at any time ( p=0.048), but not
indication for the first graft. BCVA improved in the
majority of surviving grafts and attainment of 6/12 vision
was similar for both PK-EK and PK-PK groups.
Conclusions Our registry findings suggest that repeat
PK may deliver a better outcome in terms of graft
survival than EK after a failed PK that was performed
initially for keratoconus or pseudophakic bullous
keratopathy. For surviving grafts, visual outcomes
appeared equivalent across groups
