title: Outcomes of Repeat Keratoplasty for Failed Therapeutic Keratoplasty.
abstract: OBJECTIVE
  To analyze clinical outcomes of repeat optical penetrating (PK) or endothelial keratoplasty (EK) after failed therapeutic keratoplasty (TPK).
  
  
  METHODS
  Retrospective consecutive, comparative, interventional case series.
  
  
  METHODS
  setting: LV Prasad Eye Institute, Hyderabad, India.
  
  
  METHODS
  Patients aged >18 years who underwent a repeat PK or EK following a failed TPK with a follow-up of at least 1 year were included. Patients with culture-negative ulcers, viral etiology, coexistent ocular surface disease, and multiple grafts were excluded from the study.
  
  
  METHODS
  PK or EK for failed TPK.
  
  
  METHODS
  Corrected distance visual acuity at 1 year follow-up. secondary outcome measure: Graft clarity.
  
  
  RESULTS
  One hundred twelve eyes (67 PK, 45 EK) were included in the study. The PK group had a significantly higher number of cases with high-risk features prior to regraft. Improvement in visual acuity in each of the types of grafts was statistically significant (P < .01), but there was no difference between the 2 groups at 1 year postoperatively. A statistically significant proportion of grafts regained graft clarity after regrafting in the PK group (P < .01) but not in the EK group (P = .205) at 1 year postoperatively. Endothelial rejection rates were higher in the PK group. Subgroup analysis showed that eyes that had PK or EK for failed TPK conducted for Aspergillus keratitis showed better outcomes in terms of graft clarity. Kaplan-Maier (KM) survival analysis for graft clarity showed cumulative survival of 50% at 5 years. The survival using the KM curve was not statistically different between the 2 groups (P = .33).
  
  
  CONCLUSIONS
  This study shows that visual rehabilitation with relatively good functional outcomes can be achieved by performing repeat PK or EK in patients after failed TPK.
authors.affiliation: Cornea, Anterior Segment and Refractive Surgery Services, L.V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Shreyas
authors.initials: S
authors.lastname: Ramamurthy
authors.affiliation: Cornea, Anterior Segment and Refractive Surgery Services, L.V. Prasad Eye Institute, Hyderabad, India. Electronic address: drcjagadeeshreddy@yahoo.co.in.
authors.forename: Jagadesh C
authors.initials: JC
authors.lastname: Reddy
authors.affiliation: Cornea, Anterior Segment and Refractive Surgery Services, L.V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Pravin K
authors.initials: PK
authors.lastname: Vaddavalli
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, L.V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Mohammad Hasnat
authors.initials: MH
authors.lastname: Ali
authors.affiliation: Cornea, Anterior Segment and Refractive Surgery Services, L.V. Prasad Eye Institute, Hyderabad, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Garg
mesh_terms: D000328:Adult; D003316:Corneal Diseases / Q000382:microbiology / Q000601:surgery*; D057111:Descemet Stripping Endothelial Keratoplasty; D004728:Endothelium, Corneal / Q000637:transplantation; D015818:Eye Infections, Bacterial / Q000601:surgery; D015821:Eye Infections, Fungal / Q000601:surgery; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D014786:Vision Disorders / Q000534:rehabilitation; D014792:Visual Acuity / Q000502:physiology*