Factors Affecting Regrafts in Endothelial Keratoplasty

1. Factors Affecting Regrafts in Endothelial Keratoplasty Cullen Eye Institute Department of Ophthalmology Baylor College of Medicine Houston, Texas Jennifer Li, MD, Russell Roberts, CEBT, Kirk R. Wilhelmus, MD, PhD

2. Study Purpose • To evaluate the frequency of corneal regrafting (either through repeat endothelial keratoplasty or conversion to penetrating keratoplasty) after endothelial keratoplasty using donor eye tissue distributed by the Lions Eye Bank of Texas at Baylor College of Medicine • To explore possible reasons for regrafting

3. Methods • Retrospective, cohort study • Reviewed donor corneas distributed by a single eye bank for endothelial keratoplasty from January 2004 through April 2008 • Regression analysis was performed to evaluate possible factors contributing to regrafts including: • Corneal donor and recipient demographics • Donor corneal quality score • Corneal endothelial density • Donor tissue preservation times

4. Results • From January 2004 through April 2008 • 617 eyes underwent an EK procedure • Performed by 25 corneal surgeons • 95 of 617 (15.4%) had a repeat corneal surgery • 53 of 95 (55.8%) underwent a repeat EK • 42 of 95 (44.2%) underwent a subsequent PKP

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11. Discussion • With the emergence of endothelial keratoplasty as a treatment for endothelial disease, the popularity of this procedure among ophthalmic surgeons has risen dramatically over the past four years • The technique is still in evolution as is our understanding of the factors that contribute to graft dislocation, endothelial cell loss, and ultimately, to primary graft failure.

12. Conclusions • Four possible risk factors for EK failure were observed in this study: • Donor tissue rating • Storage duration (interval from preservation to surgery) • Year of surgery • Surgeon • Multivariate analysis shows that after adjusting for confounding variables, the only significant risk factor was the interval between preservation and surgery • Study limitations: • Not an all-encompassing data set  data comes from a single eye bank; some surgeons may be obtaining donor tissue from other sources • Unable to take into account all surgical variables • Missing data (donor tissue rating and/or preservation times)