Third Penetrating Keratoplasties: Indications, Survival and Visual Outcomes

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Third Penetrating Keratoplasties Indications,
Survival and Visual Outcomes

• Nicole Fram MD, Gary Shienbaum, Brandon Ayres MD,
  Elisabeth Cohen MD, Christopher Rapuano MD,
• Kristin Hammersmith MD, Peter Laibson MD
• Wills Eye Institute
• ASCRS 2007

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Introduction to graft or not to graft

• Purpose To evaluate indications, graft survival
  and visual outcomes in third (or greater)
  penetrating keratoplasties.

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Methods

• A retrospective series of third (or greater)
  penetrating keratoplasties at Wills Eye between
  1977-2005.
• We screened all penetrating keratoplasties
  between 2000 and 2005 to find patients having the
  third transplant or more performed at Wills Eye.
  This is where we found our cohort of 34 patients
  one of which had their third graft as early as
  1977.
• Demographics
• 36 eyes of 34 patients
• 123 transplants
• Average age
• 74.7 yrs
• Gender ratio
• F/M2.3

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Results

• Failure of third grafts
• 52.8
• Mean follow up time from 3rd graft
• 35.1 months (range 1-312 months)
• Third graft survival rate
• 94 at 1 year (n34)
• 78 at 2 years (n28)
• 53 at 5 years (n19)

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Kaplan-Meier Plot of 3rd Grafts by Diagnosis
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Summary

• Prognosis for third penetrating keratoplasty is
  guarded
• Survival
• Better for stromal dystrophy and KCN
• Visual Outcome
• 3rd graft
• 12.1 gt 20/40
• 70 lt 20/200 or worse
• 4th graft or more
• 0 gt 20/40
• 80 lt 20/200 or worse
• Risk factors for 3rd graft failure
• Glaucoma
• Microbial Keratitis
• Neovascularization

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Thank You
Photographs courtesy of Christopher Rapuano, MD