{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T19:22:11Z","timestamp":1787772131521,"version":"build-2784847793"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"Suppl 2","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To determine the indications, practice pattern of immunomodulation (IM), and outcomes of repeat optical penetrating keratoplasty (OPK).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Of 4454 OPKs performed from 2016 to 2023, 259 (5.81%) were OPK following previous failed OPKs (OPK\/OPK) and these were included in the study; those with follow-up &lt;1 m were excluded. Indications for primary, last graft, risk factors, and IM use were recorded. Hazard\u2019s ratio of factors for graft failure was computed. Graft survival (clear graft at last follow-up) and graft survival time were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Prior OPK failed twice in 69 (26.64%), thrice in 41 (15.83%), and &gt;4 times in 13 (5.01%). Indications for repeat graft included rejection (83.78%), HSV (14.67%), and infection (13.90%). Pre-op IM was used in 18.91%, while post-op was in 7%. Younger age, prior therapeutic PK, corneal scars post infections, anterior segment dysgenesis, &gt;2 quadrants deep vascularization, and &gt;2 failed grafts increased risk of graft failure. Visual acuity improved at 1 month and declined after 3 months. 39% of grafts survived until last follow-up (mean 31.5 m), and the median survival time was 36 m (CI: 30.2 to 45.8 m).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>OPK\/OPK subset constitutes close to 6% of all OPKs performed, and 39% of these regrafts remain clear over a mean follow-up of 31 m. Half regrafts fail 36 m post-OPK. More than 80% of these grafts fail post rejection, and one-third post infection. Males undergo repeat OPKs more. Younger age, deep vessels, previous infections, and &gt;2 grafts pose higher risk of failure to subsequent grafts. Current IM use is limited to 7\u201320% with pre-existing high risk and needs further studies to enhance graft survival in these complex situations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_569_25","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T16:01:04Z","timestamp":1781712064000},"page":"S209-S214","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Indications and long-term outcomes of repeat optical penetrating keratoplasty"],"prefix":"10.4103","volume":"74","author":[{"given":"Tanmay N","family":"Gokhale","sequence":"first","affiliation":[{"name":"Shantilal Shanghvi Cornea Institute, Public Health, and Economics Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragukumar","family":"Venugopal","sequence":"additional","affiliation":[{"name":"Indian Health Outcomes, Public Health, and Economics Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shilpa","family":"Tarini","sequence":"additional","affiliation":[{"name":"Shantilal Shanghvi Cornea Institute, Public Health, and Economics Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anubha","family":"Rathi","sequence":"additional","affiliation":[{"name":"Shantilal Shanghvi Cornea Institute, Public Health, and Economics Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Poornima","family":"Tandra","sequence":"additional","affiliation":[{"name":"Shantilal Shanghvi Cornea Institute, Public Health, and Economics Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruti C","family":"Kotagi","sequence":"additional","affiliation":[{"name":"Shantilal Shanghvi Cornea Institute, Public Health, and Economics Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divya","family":"Tara","sequence":"additional","affiliation":[{"name":"Shantilal Shanghvi Cornea Institute, Public Health, and Economics Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Sowjanya","sequence":"additional","affiliation":[{"name":"Shantilal Shanghvi Cornea Institute, Public Health, and Economics Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sikha","family":"Misra","sequence":"additional","affiliation":[{"name":"Shantilal Shanghvi Cornea Institute, Public Health, and Economics Research Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"R1-20260813","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/01.ico.0000151503.26695.f0","article-title":"Cornea Donor Study Group. 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