We thank the authors for their interest in our article titled “Outcomes of Repeat Keratoplasty for Failed Therapeutic Keratoplasty.”
We agree that glaucoma has a role in the success of corneal transplantation. None of our patients were diagnosed to have glaucoma at the time of either optical penetrating or endothelial keratoplasty, and none developed glaucoma that required intervention during the postoperative course.
There is no strong evidence about the direct association of smoking with graft failure. We regret that in this retrospective study we could not provide the details of smoking, as there was no mention of duration and severity of smoking in the folders in many patients. The association between donor or recipient diabetes and graft failure has not been established in literature. Hence we did not collect data of the same.
The bacterial strains that we found in our serires were Pseudomonas aeruginosa in 8 cases, Pseudomonas stutzeri in 1 case, Corynebacterium sp. in 3 cases, and alpha-hemolytic Streptococcus , Staphylococcus aureus , and Staphylococcus epidermidis in 2 cases each.
It was shown earlier that the increase in the number of grafts performed will increase the risk of graft failure. Our study question in this study was to analyze the results of patients who had only 1 graft after failed therapeutic keratoplasty. Hence, Drs Gupta and Ram’s question about outcomes of patients who had 2 or more grafts is out of the scope of our present study. There is definitely a scope for further studies to compare the same. When a patient presented with an episode of graft rejection, we administered intravenous methylprednisolone 500 mg, followed by topical 1% prednisolone acetate. None of the patients was on oral steroids or cyclosporine as a maintainance dose to maintain graft clarity.