title: A comparison of endothelial and penetrating keratoplasty outcomes following failed penetrating keratoplasty: a registry study.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Ophthalmology, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Miriam C
authors.initials: MC
authors.lastname: Keane
authors.affiliation: Department of Ophthalmology, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Galettis
authors.affiliation: Department of Ophthalmology, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Richard A D
authors.initials: RA
authors.lastname: Mills
authors.affiliation: Department of Ophthalmology, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Coster
authors.affiliation: Department of Ophthalmology, Flinders University, Adelaide, South Australia, Australia.
authors.forename: Keryn A
authors.initials: KA
authors.lastname: Williams
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods*; D004728:Endothelium, Corneal / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005642:Fuchs' Endothelial Dystrophy / Q000175:diagnosis / Q000601:surgery*; D006084:Graft Rejection / Q000453:epidemiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D013021:South Australia / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors; D014792:Visual Acuity
keywords: Cornea