title: Repeat Keratoplasty for Failed Deep Anterior Lamellar Keratoplasty in Keratoconus: Incidence, Indications, and Outcomes.
abstract: OBJECTIVE
  To analyze the incidence, indications, and clinical outcomes of penetrating keratoplasty (PK) and repeat deep anterior lamellar keratoplasty (DALK) after failed DALK for keratoconus.
  
  
  METHODS
  This retrospective interventional case series reviewed the medical records of patients with keratoconus who underwent DALK and were followed up for at least 1 year. Patients who underwent PK or repeat DALK for failed DALK were identified. The incidence, indications, and clinical outcomes after repeat keratoplasty were assessed.
  
  
  RESULTS
  A total of 382 consecutive eyes with keratoconus underwent DALK over a 9-year period. Graft failure was observed in 14 eyes (3.7%). The reasons for the graft failure included nonhealing epithelial defects (n = 1), pseudoanterior chamber (n = 2), patient dissatisfaction with vision (n = 4), interface opacification (n = 4), high astigmatism (n = 1), and recurrence of keratoconus in the graft (n = 2). Of these 14 eyes with graft failure, 12 eyes underwent PK (n = 11) or repeat DALK (n = 1). At the most recent examination, which was performed 49.7 ± 25.2 months after the secondary graft, all regrafts were clear. There was no significant difference between eyes with clear first grafts and eyes that underwent PK or repeat DALK in visual outcomes at the final examination. Graft rejection was the most common complication, which was encountered in 75% of the regrafts.
  
  
  CONCLUSIONS
  The prognosis for repeat keratoplasty was excellent, and the outcomes of secondary grafts were comparable to those of primary DALK grafts. However, the rate of rejection with secondary grafts was high, necessitating close follow-up after PK and repeat DALK performed for failed DALK.
authors.affiliation: Ophthalmic Research Center, Ophthalmology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Sepehr
authors.initials: S
authors.lastname: Feizi
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Javadi
authors.forename: Pejman
authors.initials: P
authors.lastname: Khajuee-Kermani
authors.forename: Roya
authors.initials: R
authors.lastname: Jafari
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology; D006801:Humans; D015994:Incidence; D007640:Keratoconus / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D015948:Keratoplasty, Penetrating / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012029:Refraction, Ocular / Q000502:physiology; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult