Penetrating keratoplasty: indications over a 10 year period

Abstract

Aims: To determine the indications for penetrating keratoplasty (PK) at the Corneoplastic Unit and Eye Bank, UK, a tertiary referral centre, over a 10 year period. Methods: Records of all patients who underwent PK at our institution between 1990 and 1999 were reviewed retrospectively. Of the 1096 procedures performed in this period, 784 records were available for evaluation (72%). Results: Regrafting was the most common indication, accounting for 40.9% of all cases. Keratoconus was the second most common indication (15%), followed by Fuchs' endothelial dystrophy (9.3%), pseudophakic bullous keratopathy (7.6%), and viral keratitis (5.9%), which included both herpes simplex and herpes zoster and showed a statistically significant decreasing trend using regression analysis (p,0.005). Among the regraft subgroup, viral keratitis accounted for 21.2% as the underlying primary diagnosis. The most common cause for graft failure in the regraft subgroup was endothelial failure (41.8%). Conclusion: Regrafting is the leading indication for PK; viral disease-although declining-is the leading primary diagnosis. P enetrating keratoplasty (PK) is the most common tissue transplant performed in Europe and the United States. Advances in the medical management of certain diagnoses and the adoption of a conservative approach have changed patterns in the indications of PK. Moreover, the decline of certain disorders due to changes in surgical practice, and the emergence of new surgical techniques have largely influenced the changing trend. The indications for PK have continued to change since 1940, 1-3 and investigators have studied the changing trends over the past few decades. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] To update these trends we report the indications for PK from 1990 to 1999, and compare these with indications during an earlier time period at the same institution 4 and to those of other series. PATIENTS AND METHODSA retrospective analysis of records of all cases of PK performed between January 1990 and December 1999 was undertaken. All cases were performed at the Corneoplastic Unit and Eye Bank, UK, a tertiary referral centre for corneal and anterior segment disorders. Of the 1097 PKs performed in this period, only 784 medical records were available for review. Records were not accessible or had been destroyed as patients had not been followed up-either because they lived abroad, transferred to another institution, or had died. Although the indications for PK for the remaining 313 cases could be retrieved from the booking register, we elected not to include these as there was little correlation between the data recorded in the operative note and the register. Information obtained was analysed with respect to age, sex, eye grafted, and preoperative clinical diagnosis. The indications for PK were divided into seven diagnostic categories (fig 1). Regrafts were further analysed for the aetiology of failure of the previous graft and original diagnosis.Statistical significance was determined using ...

Traumatic wound dehiscence after corneal keratoplasty

“…In a study by Nagra et al (12) , the most common indication for PK among patients who developed WD was also keratoconus, followed by Fuch's endothelial dystrophy and pseudophakic bullous keratopathy. This is in contrast to the most common indication for corneal transplantation performed in the United States and United Kingdom, which is graft failure (13,14) . Other indications include pseudophakic or aphakic bullous keratopathy, Fuch's endothelial dystrophy, keratoconus, and viral keratitis (13,14) .…”

“…This is in contrast to the most common indication for corneal transplantation performed in the United States and United Kingdom, which is graft failure (13,14) . Other indications include pseudophakic or aphakic bullous keratopathy, Fuch's endothelial dystrophy, keratoconus, and viral keratitis (13,14) . In another retrospecti ve case series of 19 traumatic dehiscence with corneal grafts that underwent repair In Australia, the most common indication for the original graft was keratoconus (9) .…”

A structural investigation of corneal graft failure in suspected recurrent keratoconus

“…[1][2][3] Despite high success rates for penetrating keratoplasty (PK) for keratoconus, which have been calculated to be 98.9% at 46 months followup 4 and 93.7% at 13.8 years, 5 complications such as graft failure and keratoconus recurrence occur in a small minority of cases. [5][6][7][8][9] Previous histopathological studies on recurrent keratoconus have shown the presence of tissue abnormalities consistent with keratoconus, such as breaks in the epithelial basement membrane and Bowman's layer, abnormal keratocytes, and stromal thinning.…”

The value of corneal transplantation in reducing blindness

“…Table 5 provides information on important indications for keratoplasty in different geographical locations. [35][36][37][38][39][40][41][42][43][44] As the table shows, the important causes of corneal blindness (based on indications of keratoplasty) in Established economies are pseudophakic bullous keratopathy, keratoconus, failed grafts, and corneal dystrophy. In contrast, in less developed economies corneal scar and active keratitis are the most common indications for penetrating keratoplasty.…”