International Journal of Medical Discoveries

Background: Penetrating keratoplasty has been considered the gold standard surgical treatment for corneal blindness, as it involves the whole thickness of a diseased or scarred cornea being replaced by a healthy cornea from a donor. Purpose: To present indications, risk factors, complications and visual outcomes of penetrating keratoplasty performed at a training hospital in Turkey during 1994-1996, as a historical reference from the pre-lamellar period. Methods: Retrospective analysis of 350 PKs where indications were ranked based on clinical and histopathological pre-operative data. Corneae from the in-house eye bank were used. The primary outcome measures were graft clarity, complications and best corrected visual acuity (BCVA). Wilcoxon signed ranked test (Bonferroni correction) was used for statistical analysis performed with SPSS Version 26, with the threshold set at p < 0.05 for claiming statistical significance. Results: The top indications were keratoconus (18.0%), regrafts (14.3%) and pseudophakic bullous keratopathy (10.6%). The most frequently reported comorbidities were vascularisation (33.4%). Anterior vitrectomy and secondary IOLTA (12.6% and 10.9%) were combined procedures. The postoperative complication rate consisted of graft failure (13.1%), graft rejection (12.6%) and cystoid macular edema (3.7%). The success rate for clear grafts was 88.5% overall (96.8% for keratoconus and 68.0% for aphakic bullous keratopathy). The proportion of eyes with vision of finger counting or less reduced significantly postoperatively (86.9% to 32.6%, p<0.0001), with 28.6% of eyes having a vision of Snellen ≥0.5. Conclusions: Penetrating keratoplasty was effective at visual rehabilitation in this Turkish cohort in the 90s, especially in keratoconus. The primary challenges were graft failure and rejection, particularly in vascularised grafts and regrafting. These results are used as a baseline for comparison with the modern lamellar techniques.