[Indications for penetrating keratoplasty. A retrospective study of 2,962 cases over 11 years]

The authors report the course of penetrating keratoplasty (PK) in a series of 3,012 grafts performed at the Hôtel-Dieu de Paris Ophthalmology Department from 1980 to 1991; 2,962 cas (98.5%) could be analysed and were divided into 17 etiologic groups. In the literature, Aphakic Bullous Keratopathy (ABK) and Pseudophakic Bullous Keratopathy (PBK) are usually considered to be the most frequent PK indication. In our series, they came in third place overall with 281 cases (9.5%). Their incidence showed a constant increase over the study period, and they became the most frequent indication in 1991 (21.4% versus 6.8% in 1980). Keratoconus was the most frequent surgical indication with 813 cases (27.6%). This high percentage has been reported by other research groups. We explain our findings by a bias in the choice of corneal recipient candidates due to a tendency of the surgical team to give available donor corneas to patients with statistically higher chances of functional success. We also notice that corneal herpes sequelae, classically the leading cause of PK in the seventies, became the second indication overall and showed a decreasing tendency between 1980 and 1991. Finally, non herpetic leucomas (8.9%), graft failures (8.6%), and Fuchs dystrophy (8.3%) showed a constant PK indication rate throughout the study period.