Long-term outcomes of therapeutic penetrating keratoplasty versus elective penetrating keratoplasty in a tertiary care center in Israel

Purpose: The purpose of the study was to compare the results of therapeutic keratoplasty (TK) with those of elective penetrating keratoplasty (PK). Materials and Methods: A retrospective case–control institutional study design was used. The medical records of patients that underwent full thickness or lamellar keratoplasty between 1/2008 and 12/2015 in Rabin Medical Center (Petach Tikva, Israel) were evaluated. The study group included eyes which had TK. The control group included eyes which had PK during the study period. Outcome measures included demographic details, indication for TK, follow-up time, intraoperative and postoperative complications, the need for additional surgeries, best-corrected visual acuity (BCVA), and the presence of a clear graft at last documented visit. Results: Out of 1094 keratoplasties performed in the study period, 17 (1.55%) were therapeutic penetrating keratoplasties. The control group consisted of 240 consecutive penetrating keratoplasties. Indications for TK were severe infections (14 eyes, 82.4%) and sterile perforations (3 eyes, 17.6%). In 9/17 (52.9%) TK eyes, there was a preexisting penetrating corneal graft. Twelve corneas were perforated at the time of surgery (12/17–70.6%). Eight infected corneas were perforated at the time of surgery (8/14–57.1%). No intraoperative complications were noted for any patient. There were no differences in age and follow-up period between the groups. Primary failure rates were higher in the study group (29.4% vs. 14.6%, P = 0.15) and fewer eyes in the study group had clear cornea at last documented visit (66.7% vs. 77.5%, P = 0.48). Persistent epithelial defects and glaucoma were more common in the study group (47.1% vs. 5.0%, P < 0.0001 and 47.1% vs. 17.1%, P = 0.006, respectively), as were the need for additional surgeries (64.7% vs. 18.7%, P = 0.0001). BCVA on last visit was worse in the study group with only 11.8% having 6/45 visual acuity or better versus 41.7% in the control group (P = 0.02). Conclusions: Results of TK are inferior to those of elective PK. However, the primary purposes of TK, namely, saving the globe and maintaining useful visual acuity can be achieved in most cases. The increased complication rate and the probable need for additional procedures should be discussed with the patient.