No abstract

Objective: To examine factors affecting penetrating corneal graft survival and visual outcomes in patients under the age of 20 years.

Analysis 1.2. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 2 Postoperative BCVA (varied follow-up times, post-suture removal) (LogMAR).. .. .. .. .. .. Analysis 1.3. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 3 Postoperative functional BCVA achieved (varied follow-up times, post-suture removal).. .. .. .. . Analysis 1.4. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 4 Postoperative UCVA (varied follow-up times, post-suture removal) (LogMAR).. .. .. .. .. .. Analysis 1.5. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 5 Postoperative functional UCVA achieved (varied follow-up times, post-suture removal).. .. .. .. . Analysis 1.6. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 6 Postoperative keratometric astigmatism (varied follow-up times, post-suture removal) (D).. .. .. .. Analysis 1.7. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 7 Postoperative spherical equivalent (varied follow-up times, post-suture removal) (D).. .. .. .. .. Analysis 1.8. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 8 Postoperative keratometric astigmatism (12 months

'This is the peer reviewed version of the following article: Keane MC, Galettis RA, Mills RA, Coster DJ, Williams KA; for Contributors to the Australian Corneal Graft Registry. A comparison of endothelial and penetrating keratoplasty outcomes following failed penetrating keratoplasty: a registry study. Br J Ophthalmol. 2016 Feb 18. pii: bjophthalmol-2015-307792. doi:10.1136/ bjophthalmol-2015 which has been published in final form at after a first penetrating keratoplasty (PK), with outcomes of repeat PK after a first PK.Methods 400 eyes with a second graft (65 EK, 335 PK) performed after failure of a primary PK were identified through the Australian Corneal Graft Registry, a national prospectivelyfollowed 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.Results Poorer 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.Conclusions Our Registry findings suggest that repeat penetrating keratoplasty may deliver a better outcome in terms of graft survival than endokeratoplasty after a failed PK that was performed initially for keratoconus or pseudophakic bullous keratopathy. For surviving grafts, visual outcomes appear equivalent across groups.3