Indications for penetrating keratoplasty in north China

To analyze leading indications for penetrating keratoplasty (PKP) in north China and changing trends in them.

We retrospectively reviewed the records of patients who underwent PKP at Shandong Eye Institute from January 1997 to December 2002. Infectious keratitis (fungal, bacterial, and acanthamoeba), herpes simplex keratitis (HSK), corneal scarring, keratoconus, bullous keratopathy, regrafting, corneal dystrophy and degeneration, and others were included in the indications for PKP. Initial diagnoses and causes of regrafting were recorded, as well as the related intraocular surgeries for bullous keratopathy.

A total of 1702 patients (1702 eyes) were included in this study. The leading indications for PKP were infectious keratitis (31%), followed by HSK (18%), corneal scarring (16%), keratoconus (13%), bullous keratopathy (7%), regrafting (5%), and corneal dystrophy and degeneration (4%). Percentage of PKP for keratoconus and bullous keratopathy increased significantly during the 6 years, contrary to HSK and corneal scarring. Fungal infections accounted for 66% of infectious keratitis. Of 118 bullous keratopathy cases, 90 (76%) were associated with cataract surgery. The leading initial diagnoses of regrafting were corneal burns (25%), HSK (23%), and infectious keratitis (14%); the major causes included immune rejection (61%), graft infection (14%), and recurrence of HSK (10%).

Infectious keratitis remains the most common indication for PKP in north China. Moreover, there is an increasing trend in the percentage of PKP for keratoconus and bullous keratopathy.