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.

Figure 1

Indications for penetrating keratoplasty (PK), 1990–1999. Regraft (n = 321, 40.9%) was the most common indication for PK. Keratoconus was the second most common diagnosis (n = 118, 15%), followed by Fuchs’ endothelial dystrophy (n = 73, 9.3%), pseudophakic bullous keratopathy (n = 60, 7.6%), viral keratitis (n = 46, 5.9%), and other dystrophies (n = 28, 3.6%). These six indications account for 82.3% of indications for PK. Aphakic bullous keratopathy, injuries, interstitial keratitis, and ulcerative keratitis accounted for most of the remaining cases (n = 138, 17.6%).

Figure 2

Trends of the leading indications for penetrating keratoplasty (PK). Viral keratitis, which included both herpes simplex and herpes zoster, as an indication for PK, showed a statistically significant decreasing trend using regression analysis (A, p<0.001). Pseudophakic bullous keratopathy (PBK) increased, reaching a peak in 1999 (B, p<0.05). Fuchs’ endothelial dystrophy, regrafts, and keratoconus fluctuated over this 10 year period and did not show a statistically significant trend (C–E). The correlation coefficient r measures the closeness of fit of the data to the regression line.

Figure 3

Comparison of distribution of indications for penetrating keratoplasty at the Corneoplastic Unit and Eye Bank between 1990–99 and 1971–90. Regrafting was the most common indication in both series (40.9% and 40.8%, respectively). Keratoconus was the second most common indication and similar in both series (15% and 16.8%, respectively). Viral keratitis, which comprised 11.7% of the previous series, had a statistically significant decrease to 5.9% (p<0.005) in the present series. The frequency of both aphakic bullous keratopathy and interstitial keratitis were significantly higher in the previous series (p<0.005). Both pseudophakic bullous keratopathy and Fuchs’ endothelial dystrophy had a statistically significant increase in the present series (p<0.005).