We read with interest the recent paper by Ramamurthy and associates analyzing the clinical outcomes of repeat optical penetrating (PK) or endothelial keratoplasty (EK) after failed therapeutic keratoplasty (TPK). While the study is indeed interesting, there are certain points we wish to highlight. Firstly, patients with history of glaucoma prior to penetrating keratoplasty, particularly with prior glaucoma surgery, need to be mentioned because it is a risk factor for graft failure, as mentioned in the Cornea Donor Study. Incidence of glaucoma post optical and endothelial keratoplasty should also be mentioned. Since there is a trend toward increased graft failure in recipients who have a smoking history, this pertinent history should also have been asked. Secondly, the authors need to clarify if patients with systemic disease such as diabetes mellitus were excluded or not and whether they had poorer outcomes as compared to those without diabetes. The bacterial agents had 10 times greater hazard ratios than grafts done for Aspergillus species. Which were the most common strains of bacteria that were isolated? Thirdly, “patients with more than 2 grafts were excluded from the study.” However, how did the patients with 2 grafts fare as compared with patients who had a single graft? Lastly, no mention has been made of intake of oral steroids or systemic immunosuppressive like cyclosporine in the 2 groups postoperatively for clear graft survival and rejection-free episodes.