Indications for and outcomes of penetrating keratoplasty performed by resident surgeons

Abstract

Purpose: To analyze the indications for and outcomes of penetrating keratoplasty (PKP) performed by resident surgeons at both county hospital and Veterans Affairs facilities.

Design: Observational case series.

Methods: Retrospective review of 79 eyes from 61 patients undergoing PKP from January 1, 1997, through December 31, 2001, to determine indications for surgery and outcomes, including graft clarity and final visual acuity.

Results: There were 52 (65.8%) primary and 27 (34.2%) repeat transplants performed. Follow-up after surgery averaged 21.9 months. Indications for PKP included failed graft, 23 (29.1%), bullous keratopathy, 17 (21.5%), keratoconus, 16 (20.3%), corneal scar, 15 (19.0%), corneal perforation from infection, 5 (6.3%), and Fuchs endothelial dystrophy, 3 (3.8%). Twenty-one eyes had pre-existing ocular disease limiting final acuity. Overall, 51 grafts (64.6%) remained clear. More primary than repeat grafts remained clear (75% vs 44.4%, P =.012) and achieved 20/40 or better final acuity (30.8% vs 11.8%, P =.05). Excluding failed grafts or eyes with limited visual potential, final acuities achieved were: 19 (47.5%) 20/40 or better, 18 (45%) 20/50 to 20/150, 3 (7.5%) 20/200 or worse. Grafts remaining clear by indication were: failed graft, 9 (39.1%); keratoconus, 14 (87.5%); bullous keratopathy, 13 (76.5%); corneal scar, 10 (66.7%); corneal perforation, 2 (40%); Fuchs, 3 (100%). Eyes achieving final acuity of 20/40 or better by indication were: keratoconus, 9 (56.2%); failed graft, 3 (13%); bullous keratopathy, 3 (17.7%); corneal scar, 2 (13.3%); corneal perforation, 0 (0%); Fuchs, 2 (66.7%).

Conclusions: County hospital and Veterans Affairs facilities provide a challenging subset of patients for penetrating keratoplasty. Failed graft was the leading indication for transplantation for our population. Graft clarity and final visual acuity varied by indication for transplantation. Resident surgeons can achieve favorable results for penetrating keratoplasty performed at these venues, especially for primary transplants.