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J.I. Al–Merjan, M.G. Pandova, S.S. Reddy, T.M. Maroof; Penetrating Keratoplasty In Kuwait . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3731.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:To assess the outcome and incidence of postoperative complications in corneal grafts performed at Al Bahar Ophthalmology Center , Kuwait , between 1994 and 2002 . Methods:Diagnosis , surgical procedure and complications and at least 6 months of follow–up data of 468 penetrating keratoplasties are presented in this retrospective descriptive study . Results:The series incuded 356 patients , 238 males (70%) and 118 females (30%) , aged 7 months to 91 years , mean 48 years . Bilateral surgery underwent 33 patients (9.5%) . Major indications were keratoconus – 28% , "others " – 23.6% , regrafts – 24.3% and pseudophakic/aphakic corneal decompensation and bullous keratopathy – 12.9% . Preoperative best – corrected visual acuity was counting fingers and worse in 72% , up to 20/400 – 13.3% , up to 20/100 – in 12% , and up to 20/40 – in 1.8% . The most frequent procedures performed were penetrating keratoplasty (PKP ) – 64.2% and PKP combined with ECCE and IOL implantation – 22.8% . The inidence of early postoperative complications was 14.7% , late graft rejections – 25% and other late complications – 1.5% . Graft failure was seen in 39.8% of all first grafts , 42% of the first regrafts and 57.4% of the second regrafts . The highest incidence of first graft failure was noted in eyes with pseudophakic/aphakic decompensation and bullous keratopathy – 62.5% , and "others " – 50% . Graft failure occured within the first month in 6.1%, during the second month in 10.6% , till the sixth month in 22% , between 6 and 12 months in 18% , and during the second year in 23% . Visual acuity was improved to 20/40 and better in 62% , mainly in eyes with keratoconus – 80% . Postoperative astigmatism less than 1 D occurred in 8% of the grafts , 2 to 4 D in 41% and more than 5 D in 51% . High astigmatism was observed in similar proportions across the diagnostic categories and was more prevalent in cases with potoperative visual acuity less than 20/40 . Conclusions:There was a marked prevalence of male patients in our series . The overall success rate was related to the diagnostic category , and was highest in eyes with keratoconus and corneal dystrophy . Previous grafts and others intraocular surgeries were associated with the highest risk of early and late complications and graft failure. These patients had less improvement in their visual acuity even when the graft remained transparent . Further analysis will provide better understanding of the factors that determine vision rehabilitation after PKP.
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