Clinical indications of penetrating keratoplasty in a tertiary care centre of North India

Abstract

Background: Corneal diseases are one of the major causes of blindness and visual impairment in developing countries. Penetrating keratoplasty is a surgical procedure where a damaged or diseased cornea is replaced by donor corneal tissue. Aim was to determine the indications of penetrating keratoplasty (PK) in a tertiary health care centre of North India.Methods: A retrospective analysis of the records of 288 patients, who underwent penetrating keratoplasty (PK) from January 2016 to December 2018 at Regional Institute of Ophthalmology, PGIMS Rohtak were included in this study. All patients who underwent PK during this time period were included in our study except those who underwent regrafting.Results: A total of 288 patients who underwent penetrating keratoplasty (PK) surgery were included in our study. Out of 288, 184 (63.88%) were males and 104 (36.11%) were females. In our study, 162 (56.25%) patients underwent optical PK, 76 (26.38%) had tectonic PK and 50 (17.36%) underwent therapeutic PK. Most common indication for optical PK was bullous keratopathy followed by corneal opacity. Most common reason for tectonic PK was found to be corneal perforation while for therapeutic PK was sloughing corneal ulcer followed by recalcitrant fungal keratitis.Conclusions: Though bullous keratopathy (BK) was the most common indication for penetrating keratoplasty in North India, but in our study 27% patients had tectonic PK and 17% patients underwent therapeutic PK which is significantly higher than documented data from South India and developed countries. It can be because of low literacy level, lack of awareness and late presentation to ophthalmologist in North India.

Trends in keratoplasty from central and Northern India. Part I: Indications for keratoplasty

“…Unlike, north America, Europe, and a few Asian countries,[ 7 8 12 13 15 16 ] corneal dystrophies and keratoconus were not the leading indications of keratoplasty in our study or ever have been in other studies from India. [ 17 18 19 20 21 22 23 35 ] In India, Fuchs endothelial corneal dystrophy is reported to be the commonest corneal dystrophy,[ 37 ] and it was also the leading indication among corneal dystrophies in our study. The number of corneal dystrophies undergoing keratoplasty increased significantly between 2012 and 2021, which is due to the overall increase in keratoplasty procedures during this period.…”

“…Re-grafts are the most common indication for penetrating keratoplasty in the United States,[ 12 ] the second most common indication for keratoplasty in Europe[ 13 ] and Japan,[ 16 ] the third most common indication in the United Kingdom,[ 7 ] Canada,[ 8 ] and India. [ 17 18 19 20 21 22 23 ] In India, failed grafts constituted between 10% and 17% of all patients undergoing or registered for keratoplasty. [ 17 18 19 20 21 22 23 35 ] The indications of keratoplasty are an important prognosticator of graft survival, and indications like corneal ulcers and corneal scars carry a poor or moderate prognosis.…”

“…[ 17 18 19 20 21 22 23 ] In India, failed grafts constituted between 10% and 17% of all patients undergoing or registered for keratoplasty. [ 17 18 19 20 21 22 23 35 ] The indications of keratoplasty are an important prognosticator of graft survival, and indications like corneal ulcers and corneal scars carry a poor or moderate prognosis. [ 36 ] As these two corneal diseases were the most common indications in our study, it is natural that a failed graft was the third most common cause of keratoplasty.…”

“…[ 4 14 ] Within India, there appear to be local differences, with few studies reporting corneal scar as the leading indication,[ 17 18 19 ] while other studies have reported corneal ulcers,[ 20 21 22 ] and only one study has reported post-cataract surgery corneal edema to be the commonest indication. [ 23 ] The present study was designed to explore the regional variation in indications of keratoplasty in central and north India and analyze the trends and patterns in the last two decades.…”