Indications, surgical procedures and outcomes of keratoplasty at a Tertiary University-based hospital: a review of 10 years' experience

Objective To investigate keratoplasty outcomes in a university-based hospital. Methods Medical records of all patients undergoing keratoplasty at King Abdulaziz University Hospital, Riyadh, Saudi Arabia, between January 1, 2006, and December 31, 2015, with a minimum follow-up period of three months were reviewed retrospectively. Indications, surgical procedures, complications and outcomes of all surgeries were collected and analyzed. Main outcome measures Graft survival and visual acuity. Results Data were available for 488 grafts in the study period, including 313 optical penetrating keratoplasty (PKP), 42 therapeutic/tectonic PKPs, 72 deep anterior lamellar keratoplasty, 58 Descemet's stripping automated endothelial keratoplasty and 3 Descemet's membrane endothelial keratoplasty. A total of 389 (79.7%) grafts survived, whereas 99 (20.3%) grafts failed. The projected 1-year, 3-year and 5-year cumulative survival rates for the entire study group were 85.8%, 74.9% and 71.1%, respectively. Corneal ectasia was the commonest surgical indication accounting for 48% of the cases. The best long-term survival rates were observed in the stromal dystrophy and corneal ectasia groups. The worst survival rates were noticed in the congenital corneal opacities group. Vision improved in in 57.5% of grafted eyes, remained the same in 39.8% and deteriorated in 2.7%. Postoperative complications occurred in 36% of the grafts with rejection being the most common, and its mere occurrence increased the risk of graft failure by 20-fold. Conclusion The outcome of grafting in a university-based hospital can be excellent in low-risk grafts and fair to low in high-risk grafts. Our results are relatively comparable to nationally and internationally reported outcomes.

Automated summary

The study investigated keratoplasty outcomes in a university-based hospital, finding a high graft survival rate of 79.7% with optical penetrating keratoplasty being the most common procedure. Corneal ectasia was the most common surgical indication, with vision improvement observed in 57.5% of grafted eyes. Postoperative complications occurred in 36% of grafts, with rejection being the most common complication.