One Year Cross-Sectional Study of Visual Outcome and Graft Survival in Penetrating Keratoplasty at KLES Dr. Prabhakar Kore Hospital and Medical Research Centre,Belagavi

Abstract

Background and objectives Corneal blindness is one of the most challenging public health problems all over the world, especially in developing countries like India, where it is one of the leading cause of visual disability. Penetrating keratoplasty (PK) is the mainstay surgical treatment of corneal blindness and is a well-established fact. Common causes of corneal opacity are keratitis, trauma, phakic or pseudophakic bullous keratopathy, adherent leucoma, corneal dystrophies and keratoconus. In patients with both corneal and lenticular opacities, combined cataract extraction/intraocular lens (IOL) insertion with penetrating keratoplasty (PK), which is known as the triple procedure, is one treatment option. This study is undertaken to elucidate various aspects of keratoplasty, including indications, pre-operative assessment, surgical techniques, post-operative management, complications, anatomical and functional outcome. Objectives of this study are: 1. To analyze the visual outcome after penetrating keratoplasty. 2. To evaluate the intra-operative and post-operative complications after penetrating keratoplasty. 3. To study factors affecting graft survival after penetrating keratoplasty. Methodology The present study is a one year cross-sectional study conducted in the Department of Ophthalmology, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi on patients undergoing penetrating keratoplasty during the period between 1st January 2015 – 31st December 2015. This study was approved by the Ethical and Research Committee of Jawaharlal Nehru Medical College, Belagavi. The patient underwent penetrating keratoplasty/ triple procedure (according to need) to evaluate the visual outcome and graft survival after surgery. Results The mean age was 50 + 2.3 yrs. Majority of the patients were in the range of 51-60 yrs that is 45%. There was a male preponderance in the study (65%). The most common indication was corneal scarring due to various causes (70%), followed by keratitis (20%) and corneal dystrophies (10%). Co-relation between enucleation and transplant time was statistical significant using Fisher Exact test with p value <0.001. The time interval between retrieving the donor cornea and the outcome of graft was statistically significant with p value of 0.039 using Fisher Exact test. 88.88% patients with post-operative complication went into graft failure and 11.11% had graft survival even with complications. 60% of had successful grafts and 40% patients had graft rejection. Conclusions and interpretation On conclusion of this study, 60% patients had successful keratoplasty and 40% went in graft failure. The survival of the graft is dependent on various factors like time interval between the enucleation time and transplant, age of the donor cornea, recipient age, intra and post-operative complications and the suturing techniques.