Outcomes Of Therapeutic And Tectonic Penetrating Keratoplasties In A Developing Country

Despite current advances in pharmacological and surgical treatment, severe corneal infections, injuries, or systemic diseases can lead to corneal perforations, which frequently require surgery. Urgent reconstructive surgical interventions may be necessary to avoid consecutive endophthalmitis, spread of infection, loss of sight or loss of eye. In developing countries usually, the presentation to the treating ophthalmologist is late, when the disease is already quite advance, and the eye may not be salvageable. This is further complicated by poor compliance to follow ups and treatment. Here we report outcomes of tectonic and therapeutic keratoplasty performed in a tertiary eye care center in Saudi Arabia. 

Tertiary eye care hospital (king Khaled eye specialist Hospital, Riyadh, Saudi Arabia)

Retrospective review of the medical records of all patients who underwent tectonic or therapeutic full thickness keratoplasty between June 1, 2014, and December 31, 2018. All patients with at least two years of follow-up postoperatively were included in the study. Details collected were demographics details, preoperative data like indication of surgery, duration and cause of microbial keratitis, duration of perforation, size of perforation or infiltrate, associated complications, and medical treatment before the surgery. Intraoperative details included size of recipient and donor, any combined surgery, result of corneal button culture and biopsy. Visual acuity, clarity of graft and recurrence of disease were main outcome measures.

90 keratoplasties fulfilling the criteria were performed during this period. There were 51 males and mean age was 52 years. The mean follow-up was 3.8 years. 76.7% of the eyes had microbial keratitis, 8.9% had immune mediated perforation, 8.9% had trauma and the rest were melt due to variety of reasons. Among the microbial keratitis group, 40.6% had bacterial infection, 34.8% had fungal infection, 15.9% viral and 2.9% protozoan. The mean visual acuity at presentation was 1.97 logMAR. 45 eyes underwent therapeutic, and the rest underwent tectonic keratoplasty. The survival rate at 6,12, 18 & 24 months were 54.2%, 29.8%, 19.3% & 8.8% respectively. Larger graft & autoimmune disease were positively co-related with graft failure. 

In developing countries, the graft survival after therapeutic / tectonic keratoplasty is quite low presumably due to late presentation and poor compliance. Advanced infection (needing larger graft) and perforation due to autoimmune disease carries worse prognosis.