Risk Factors for Repeat Keratoplasty After Endothelial Keratoplasty An IRIS Registry Analysis

center dot PURPOSE: To assess risk factors for repeat keratoplasty after endothelial keratoplasty (EK).center dot DESIGN: Retrospective cohort study.center dot METHODS: EK procedures performed between 2013 and 2018 in the IRIS Registry (Intelligent Re-search in Sight) were identified. Study Population : Pa-tients aged 18 years and older who underwent EK. Main Outcome Measures : (1) Risk factors for repeat ker-atoplasty and (2) complication rates after EK. A Kaplan -Meier survival analysis was used to determine the prob-ability of repeat keratoplasty. A multivariable shared frailty survival model was used to assess risk factors.center dot RESULTS: A total of 59 344 procedures were identified in the registry, of which 30 600 EK procedures met the inclusion criteria for the analysis. The probability of repeat keratoplasty was 17.4% (95% CI 16.7-18.0) at 5 years. Risk factors for repeat keratoplasty include post-operative rebubbling procedure (HR 2.24, 95% CI 2.05-2.45), prior failed graft (HR 2.07, 95% CI 1.84-2.32) or bullous keratopathy (HR 1.47, 95% CI 1.33-1.61) vs Fuchs dystrophy as surgical indication; subsequent routine cataract surgery (HR 1.61, 95% CI 1.45-1.79), as well as subsequent (HR 1.53, 95% CI 1.39-1.69) and prior/concurrent (HR 1.23, 95% CI 1.11-1.36) glaucoma surgery or history of glaucoma (HR 1.24, 95% CI 1.14-1.35). Medicaid (HR 1.47, 95% CI 1.13-1.92), military/government (HR 1.29, 95% CI 1.03-1.60), Medicare Fee-for-Service (HR 1.17, 95% CI 1.05-1.31) or Medicare Managed (HR 1.17, 95% CI 1.01-1.36) insurances vs private insurance, as well as Black vs White race (HR 1.25, 95% CI 1.11-1.40) and smoking (HR 1.16, 95% CI 1.05-1.27) were also associated with an increased risk of undergoing repeat keratoplasty.center dot CONCLUSIONS: Black race, government-based insur-ance plans, and smoking were identified as indepen-dent factors associated with repeat keratoplasty in addi-tion to history of glaucoma, glaucoma surgery, and prior graft failure or bullous keratopathy as surgical indication.(Am J Ophthalmol 2022;242: 77-87.(c) 2022 Elsevier Inc. All rights reserved.)

Automated summary

This study retrospectively identified risk factors for repeat keratoplasty after endothelial keratoplasty (EK). It found that black race, government-based insurance plans, and smoking were associated with an increased risk of undergoing repeat keratoplasty, along with a history of glaucoma, glaucoma surgery, and prior graft failure or bullous keratopathy as surgical indications.