Large diameter therapeutic penetrating keratoplasties

Fourteen penetrating keratoplasties were done on ten patients using 9.5 mm or larger diameter grafts. The causes for large grafts were perforation or impending perforation of large descemetoceles due to bacterial ulceration in five eyes, herpes simplex viral keratouveitis in three eyes, severe keratoconjunctivitis sicca with ulceration in four eyes, alkali burn and Mooren's ulcer in one eye each. The average duration of graft clarity was 67.2 days (range 14 days to 6 months). The best spectacle corrected visual acuity range was from l.p. to 20/40. Two patients had recurrent ulceration requiring two large diameter regrafts each. The average period of clarity in these repeated grafts was 26 days. A small graft placed inside of the failed large graft remained clear in 50% of the six eyes which were done for visual restoration. A large diameter penetrating keratoplasty may salvage an eye that might have otherwise been lost and in a few cases provide the opportunity for useful vision.