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. 2023 Sep;71(9):3171-3177.
doi: 10.4103/IJO.IJO_1344_23.

Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India

Josephine S Christy  1 , Priya Mathews  2 , Rashmita Ravisankar  1 , Esen K Akpek  2
Affiliations

Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India

Josephine S Christy et al. Indian J Ophthalmol. 2023 Sep.

Abstract

Purpose: This study aimed to review the demographics, clinical characteristics, and long-term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital.

Methods: Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow-up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes.

Results: The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6-month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three-year follow-up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty.

Conclusion: Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome.

Keywords: Anatomical success; infectious keratitis; therapeutic keratoplasty outcomes; therapeutic success.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Images showing the course of a good quality donor button used for TPK. (a) Postoperative day 1 showing minimal graft edema and inflammation with adequate host margin (b) Clear graft at 2-month follow-up (c) Graft rejection at 2-year follow-up (d) Clear cornea post-DSEK at 3-year follow-up
Figure 2
Figure 2
Images showing various types of postoperative outcomes (a) Recurrent graft infection (b) Graft melt (c) Primary graft failure after successful medical treatment (d) Extensive peripheral anterior synechiae in a large graft that required synechiae release and anterior chamber reformation
Figure 3
Figure 3
Images showing poor preoperative prognostic factors (a) Perforated corneal ulcer (b) Large corneal ulcer with limbal involvement and hypopyon (c) Severely inflamed eye with corneal ulcer (d) Recurrent total graft infection
See this image and copyright information in PMC

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