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

Hyeck Soo Son, Flora Lum, Charles Li, Oliver Schein, Sudeep Pramanik, Divya Srikumaran

Research output: Contribution to journalArticlepeer-review


Purpose: To assess risk factors for repeat keratoplasty after endothelial keratoplasty (EK). Design: Retrospective cohort study. Methods: EK procedures performed between 2013 and 2018 in the IRIS Registry (Intelligent Research in Sight) were identified. Study Population: Patients aged 18 years and older who underwent EK. Main Outcome Measures: (1) Risk factors for repeat keratoplasty and (2) complication rates after EK. A Kaplan-Meier survival analysis was used to determine the probability of repeat keratoplasty. A multivariable shared frailty survival model was used to assess risk factors. 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 postoperative 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. Conclusions: Black race, government-based insurance plans, and smoking were identified as independent factors associated with repeat keratoplasty in addition to history of glaucoma, glaucoma surgery, and prior graft failure or bullous keratopathy as surgical indication.

Original languageEnglish (US)
Pages (from-to)77-87
Number of pages11
JournalAmerican journal of ophthalmology
StatePublished - Oct 2022

ASJC Scopus subject areas

  • Ophthalmology


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