Tectonic and Therapeutic Urgent Penetrating Keratoplasty Outcomes

OBJECTIVES: It was aimed to to provide a comprehensive assessment of therapeutic and tectonic emergency keratoplasty procedures, along with a discussion on their indications, prognostic factors for functional success, and postoperative outcomes.
METHODS: Patients who underwent therapeutic or tectonic Penetrating Keratoplasty (PKP) procedures between 2010 to 2021 in our hospital were retrospectively reviewed. Patient files were evaluated in terms of demographic characteristics, medical and ocular history, visual acuity, initial ocular findings, presence of glaucoma, causative microorganisms, details of surgical procedures, complications, graft transparency and globe integrity. Visual acuity was measured as light perception, hand motion, counting finger, Snellen chart and subsequently converted to Logarithm of the Minimum Angle of Resolution (logMAR) for statistical analysis.
RESULTS: The study included a total of 43 patients, with 16 (37.2%) being female. The average age of the participants was 59.72±18.1 years. The corrected distance visual acuity improved from 2.3±0.66 logMAR preoperatively to 1.72±1.02 logMAR postoperatively (p=0.001). After PKP, anatomical success was achieved in all eyes and functional success was achieved in 23 (51.1%) eyes. It was observed that only preoperative glaucoma had a significant impact on graft survival rate (p=0.002, Figure 2), as well as functional success (p=0.022).
DISCUSSION AND CONCLUSION: Urgent keratoplasty is a viable treatment option for cases involving an actively uncontrolled infection or corneal disease with perforation. In cases of graft rejection, bacteria, fungi, and viral pathogens were detected as causative agents, whereas only bacteria were detected as the causative agents in cases of pre and post-operative endophthalmitis. Early diagnosis and treatment play crucial roles in achieving anatomical and functional success.