Large-diameter penetrating keratoplasty: indications and outcomes

To report the indications and outcomes of patients who underwent large-diameter penetrating keratoplasty (LDPK) for the management of peripheral corneal disease.

A retrospective chart review and data analysis of patients who underwent LDPK was performed.

A retrospective chart review of 35 eyes of 32 patients undergoing LDPK between May 2000 and December 2006 at the Cincinnati Eye Institute/University of Cincinnati was completed. Corneal grafts 8.75 mm or larger were designated as large grafts. Graft diameter ranged from 8.75 mm to 10.0 mm. Indications for cornea transplantation included keratoconus (19), pellucid marginal degeneration (two), keratoconus and pellucid marginal degeneration (five), Fuchs endothelial dystrophy (one), corneal stromal scar (one), postradial keratotomy irregular astigmatism (two), and repeat penetrating keratoplasty (five). No evidence of preoperative stromal neovascularization was seen in any eye. Five of 35 eyes had experienced one previous graft failure. Minimum follow up was 12 months (range, 12-91 months) with a mean follow up of 29.8 months. Preoperative best-corrected visual acuity was 20/100 (range, 20/25 to hand movements), and postoperative best-corrected visual acuity was 20/32 (range, 20/20-20/125). Postoperatively, 43% of patients had 20/40 or better uncorrected visual acuity. Average postoperative manifest cylinder was +2.19 D (range, none to +4.75 D) with 77% of patients having less than +3.00 D of cylinder. The postoperative immunosuppression regimen included topical corticosteroid and topical cyclosporine 0.05%. The incidence of cataract formation in our study was 14.2%. The incidence of secondary glaucoma was 8.8%. Cornea graft rejection was noted in six of 35 eyes with resolution in 4/6. Repeat cornea transplant was required in one of six eyes for severe infectious keratitis, and one of six eyes was lost to follow up. At last follow up, 33 of 35 original grafts were clear with one graft lost to follow up and one eye requiring repeat keratoplasty. No graft rejection was experienced by any patient with a history of prior graft failure.

LDPK may result in less postoperative astigmatism without an increased risk of graft failure if managed correctly postoperatively. Topical cyclosporine 0.05% may be a useful adjunct to decrease the incidence of graft rejection and failure. Ophthalmologists performing penetrating keratoplasty should consider a LDPK to reduce postoperative astigmatism and improve visual acuity outcomes in their patients.