Penetrating keratoplasty: indications, outcomes, and complications

• Published in: Eye (London) Vol. 23; no. 6; pp. 1288 - 1294
• Main Authors: Rahman, I, Carley, F, Hillarby, C, Brahma, A, Tullo, A B
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.06.2009; Nature Publishing Group
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Child; clinical-study; Female; Glaucoma - epidemiology; Graft Survival - physiology; Humans; Incidence; Keratitis - epidemiology; Keratoplasty, Penetrating - methods; Laboratory Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; Ophthalmology; Outcome Assessment (Health Care); Pharmaceutical Sciences/Technology; Postoperative Complications; Retrospective Studies; Risk Factors; Surgery; Surgical Oncology; Visual Acuity; Young Adult; risk factors; complications; corneal transplantation; long-term follow-up; survival; Cornea; Prognosis; Indication; Transplantation; Penetrating graft; Long term; Survival; Treatment; Keratoplasty; Surgery; Risk factor; Complication; Evolution; Ophthalmology
• ISSN: 0950-222X; 1476-5454
• DOI: 10.1038/eye.2008.305

Purpose Corneal transplantation is the most common form of transplantation with approximately 2500 grafts undertaken annually in the United Kingdom. The modern day success of transplantation is attributed to eye bank storage techniques, ocular pharmacology, and improved surgical techniques. Methods This retrospective case note review identified 203 penetrating keratoplasties (PKs) performed during a period from 1 January 2000 to 31 December 2003 at Manchester Royal Eye Hospital. Preoperative risk factors, surgical technique, postoperative complications, and Snellen acuity were analysed. Results The mean age of the recipient group was 56.7 years, with 107 right eyes and 96 left eyes. The mean follow-up was 61 months. The overall 5-year survival was 82%, with keratoconus and corneal dystrophies at 93 and 89%, respectively. Visual acuity had improved to 6/12 or better in 48% of patients postoperatively, compared with 8% preoperatively. Forty-three donor grafts (21%) underwent at least a single episode of endothelial rejection. Glaucoma was a finding in 37 (18%) of patients following PK. In all, 16 grafts of 15 patients were noted to have suffered microbial keratitis (MK), an incidence of 8%. Conclusions PK is currently an effective long-term treatment option for improving visual function. An overall survival rate of 82% over 5 years is comparable with other published studies and is largely dependent on recipient factors. This report emphasises the significant complications of immunological rejection, glaucoma, and microbial keratitis, which continue to limit success.