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Penetrating keratoplasty in Nepal
Geoffrey C Tabin1, Rita Gurung, Govinda Paudyal
1Department of Opthalmology, University of Vermont College of Medicine, Burlington 05401, USA. geoffrey.tabin@vtmednet.org
Purpose:
To identify indications and outcomes in a large series of penetrating keratoplasty surgeries performed in Nepal.
Methods:
A retrospective case series of 472 consecutive penetrating keratoplasty surgeries (408 patients) performed at Tilganga Eye Center, Kathmandu, Nepal from June 1994 to September 1999.
Results:
Mean recipient age was 39.2 years (+/- 19.7 years). Main indications for PKP were corneal scar (37%), adherent leukoma (35%), perforation or impending perforation (9%), pseudophakic bullous keratopathy (6%), keratoconus (4%), and aphakic bullous keratopathy (3%). Mean duration of follow-up was 27.6 +/- 25.1 months. Sixty-five percent of available grafts were clear at 6 months, and 70% of available grafts were clear at 3 years. Six months postoperatively, 15% of patients had acuity better than 6/18, 37% had acuity between 6/18 and 6/60, and 17.7% had acuity between 6/60 and 3/60. Common causes of graft failure were endothelial failure (43%), increased intraocular pressure (15%), ulcer (14%), and trauma (7%).
Conclusions:
The corneal diseases and indications for transplant surgery in Nepal are different from those in the Western world. Despite these differences, penetrating keratoplasty is a successful and reasonable way to reduce corneal blindness in developing nations.