Aboshiha J, et al. - Experts evaluated the corneal transplant replacement survival rates for the 3 main indications and types of regraft surgery. Data demonstrated variation in the regraft survival with an indication for first graft surgery and for Fuchs endothelial dystrophy (FED) with type of regraft procedure performed. This is a large registry-based analysis of corneal regraft survival. For FED and pseudophakic bullous keratopathy (PBK), they did not note an association of the permutation of graft and subsequent first regraft procedure with any survival benefit for the first regraft. Decision-making in the management of a failed corneal transplant could be assisted by these reported outcomes.

Methods

• Authors in this national transplant registry study evaluated surgery and follow-up data on all corneal transplants performed in the United Kingdom from April 1, 1999, through March 31, 2016.
• They compared the actuarial regraft 5-year survival rates for the 3 main indications and types of graft: penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty for keratoconus, PK and endothelial keratoplasty (EK) for Fuchs endothelial dystrophy (FED), and pseudophakic bullous keratopathy (PBK).

Results

• As per data, during the 17-year study period, a total of 9925 regrafts were analyzed.
• Findings suggested that 7261 cases (73.2%) were represented by penetrating keratoplasty in the cohort.
• Results demonstrated the increase in endothelial keratoplasty by 1361.5%, from 12 (2.6%; 95% CI, 1.3%-4.5%) of all 467 regrafts during 2005-2006 to 292 (38.0%; 95% CI, 34.6%-41.6%) of 768 during 2015-2016.
• Results demonstrated that for all graft types, median time to first regraft was 28 months (interquartile range, 10-64 months).
• Data suggested that when examining all graft types performed for all indications, stratification of 5-year survival was found for successive grafts, with a difference in survival of 25,270 (72.5%; 95% CI, 71.7%-73.2%) from the first graft to 4224 (53.4%; 95% CI, 51.4%-55.4%) from the second graft and 1088 (37.3%; 95% CI, 33.4%-41.3%) from the second to third graft.
• Authors noted a similarity of survival after lamellar and PK procedures for first regrafts in keratoconus and PBK.
• There was a higher regraft survival after PK (375 [70.8%]; 95% CI, 64.6%-76.1%) vs EK (303 [54.7%]; 95% CI, 45.8%-62.8%) for FED (P < .001).
• For FED and PBK, they did not note any difference in first regraft survival identified between EK followed by PK vs PK followed by PK or EK followed by EK vs PK followed by EK.