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  • Cornea/External Disease

    Review of: Risk factors for repeat keratoplasty after endothelial keratoplasty—An IRIS Registry analysis

    Son H-S, Lum F, Li C, et al. American Journal of Ophthalmology, October 2022

    Using data from the IRIS Registry, investigators identified the incidence of repeat keratoplasty after endothelial keratoplasty (EK) and associated risk factors.

    Study design

    This study investigated data from the IRIS Registry, and identified patients aged 18 years or older who underwent EK between 2013 and 2018. The primary outcome was the incidence of repeat keratoplasty and associated risk factors and clinical characteristics.


    Overall, 30,600 EK procedures were included in the analysis with an average follow-up time of 2.7 years. Approximately 17% of cases underwent repeat keratoplasty after 5 years. The study identified several important sociodemographic factors for repeat keratoplasty including Black race, active smoking, and government insurance. A number of clinical characteristics were associated with repeat keratoplasty including indication for EK, postoperative rebubbling, preexisting glaucoma, and subsequent cataract surgery.


    Several limitations were noted. Firstly, repeat keratoplasty likely underestimates the frequency of graft failure. Additionally, the study did not differentiate between DSEK and DMEK due to limitations from the use of CPT coding. Finally, the IRIS Registry relies on ICD and CPT codes to categorize patients, and there may be variations based on surgeon documentation.

    Clinical significance

    Consideration of the data presented in this study may lead to enhanced patient counseling prior to EK and may also help to guide postoperative planning. This study increases awareness of socioeconomic and racial disparities that are associated with EK outcomes.