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Patients with more than three corneal grafts face poor outcomes

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PHILADELPHIA — Surgeons should consider alternatives to penetrating keratoplasty for patients who receive more than three corneal grafts, according to a surgeon speaking here.

Nicole Fram, MD, and colleagues reviewed the prognosis, graft survival rate and visual outcomes for patients treated with a third penetrating keratoplasty procedure at Wills Eye Hospital between 1977 and 2003. She presented the results of the 26-year retrospective study at the 2007 Wills Eye Hospital Annual Alumni Conference.

The study included 14 patients who received 45 transplants overall. Six eyes (40%) were clear centrally at the latest examination. Nine eyes (60%) attained a final visual acuity of 20/40 or better, and all eyes had final visual acuity of 20/200 or better, Dr. Fram said.

Overall, the grafts had a 53% survival rate, Dr. Fram said. Nine eyes (60%) required corneal regrafting, and four patients had more than three regrafting procedures. Of these four patients, one attained final visual acuity of 20/200 and three had poor visual acuities and required another corneal transplant, she said.