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Long-Term Changes in Corneal Endothelial Cell Density after Repeat Penetrating Keratoplasty in Eyes With Endothelial Decompensation

Hayashi, Ken MD; Kondo, Hiroyuki MD; Maeno, Aya MD; Takimoto, Minehiro MD

doi: 10.1097/ICO.0b013e31827c0b76
Clinical Science

Purpose: To compare the longitudinal changes in corneal endothelial cell density (ECD) and the incidence of postoperative complications between eyes with endothelial decompensation after repeat penetrating keratoplasty (RPK) and those after primary penetrating keratoplasty (PPK).

Methods: Fifty-seven eyes with endothelial decompensation scheduled for RPK (RPK group) and 57 eyes with endothelial decompensation scheduled for PPK (PPK group) were enrolled. Corneal ECD was evaluated using a specular microscope at 1, 3, 6, 9, and 12 months, and every 6 months until 60 months postoperatively. Visual acuity (VA) and incidence of graft failure, graft rejection, or marked increase in intraocular pressure were examined.

Results: Corneal ECD decreased gradually and percentage of cell loss at 60 months was approximately 73% in both groups; these did not differ significantly between groups throughout the follow-up (P ≥ 0.2209). The incidence of graft failure (52.6% in the RPK group and 36.8% in the PPK group), immune rejection, and marked increase in intraocular pressure did not differ significantly between groups (P ≥ 0.0898), although corrected VA was worse in the RPK group. The most common cause of graft failure in both groups was late endothelial failure. The outcomes were not significantly different between eyes that underwent a first RPK and those that underwent a second or subsequent RPK.

Conclusions: Corneal endothelial cell loss and complications are comparable between eyes with endothelial decompensation after RPK and those after PPK, although VA is worse in eyes after RPK. The outcomes after a first RPK did not differ from those after multiple RPKs.

Supplemental Digital Content is Available in the Text.

*Hayashi Eye Hospital, Fukuoka, Japan

Department of Ophthalmology, University of Occupational and Environmental Health, Fukuoka, Japan.

Reprints: Ken Hayashi, Hayashi Eye Hospital, 4-7-13 Hakataekimae, Hakata-Ku, Fukuoka 812-0011, Japan (e-mail:

The authors have no financial or conflicts of interests to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Received September 02, 2012

Accepted October 31, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.