Large-Diameter Penetrating Keratoplasties are Mostly Due to Very Severe Infectious Keratitis and Cannot Always Prevent Secondary Enucleation.

PURPOSE: To report the indications and outcomes of penetrating keratoplasties with a graft diameter > 8.5 mm in severe corneal diseases at the Department of Ophthalmology at Saarland University Medical Centre. STUDY DESIGN: Retrospective (6 years), descriptive, and observational. METHODS: Thirty-five large-diameter penetrating keratoplasties (LDPKPs) in 27 patients (mean age, 62 ± 22 years) were performed from March 2010 to December 2016. The indication for surgery, number of previous corneal transplantations, best-corrected visual acuity (BCVA) before surgery, intraocular pressure, graft status, and BCVA at last follow-up were recorded. RESULTS: Infectious keratitis represented 83% of the indications (of those, 45% fungal). The mean corneal graft diameter was 10.8 ± 1.7 (min 8.75, max 15.0) mm. Twenty-three eyes (65% absolute) had at least one previous penetrating keratoplasty (mean graft size, 9.2 ± 1.6 mm). The mean pre-surgery BCVA was 1.96 ± 0.23 logMAR. With a mean follow-up period of 20.2 ± 13.4 months, the mean BCVA was 1.57 ± 0.57 logMAR at last follow-up. Overall, 12 grafts (35%) remained clear until the last follow-up, and in 23 grafts (65%), the primary disease recurred, or corneal decompensation developed. Up to the last follow-up, 6 eyes (17%) had to be enucleated. CONCLUSIONS: In complex cases of infectious keratitis requiring a LDPKP to remove the complete pathology and preserve eye integrity, the visual outcomes are generally expected to be poor, not only because of the well-known risks of LDPKP but also because of the consequences of the infectious disease itself. This knowledge is important for adequate counselling of the patient preoperatively.

8.5/8.6-mm Excimer Laser-Assisted Penetrating Keratoplasties in a Tertiary Corneal Subspecialty Referral Center: Indications and Outcomes in 107 Eyes.

PURPOSE: To report the indications and outcomes of 8.5/8.6-mm excimer laser-assisted penetrating keratoplasties (PKPs) at a tertiary corneal subspecialty referral center. METHODS: This retrospective, descriptive, observational study included 107 PKPs performed in 96 patients (mean age, 53 ± 12 years). The patients' indications for surgery, best-corrected visual acuity, surface regularity index, surface asymmetry index, topographic astigmatism, central endothelial cell density, central corneal thickness, and graft status were recorded preoperatively, 6 weeks postoperatively, and before (12 ± 2 months) and after (19 ± 4 months) the suture removal. RESULTS: The surgeries included 48 primary PKPs and 59 repeat PKPs. The main indications were corneal ectatic disorders (50%), severe corneal keratitis (21%), and corneal scars (16%) in the primary PKP group and highly irregular astigmatism after PKP (51%) and previous graft decompensation (37%) in the repeat PKP group. From preoperative measurements to the last follow-up visit without sutures, we found significant improvements (P < 0.001 for all) in visual acuity (0.7 ± 0.3 LogMAR to 0.3 ± 0.2 LogMAR), surface regularity index (1.5-1.0), and surface asymmetry index (2.59-1.1). At the last follow-up, the mean outcome measurements did not significantly differ between the primary and repeat PKP groups. Overall, 89 grafts (83%) remained clear at the last follow-up. CONCLUSIONS: In cases of ectatic disorders and highly irregular astigmatism after keratoplasty, 8.5/8.6-mm excimer laser-assisted PKP seems to be an excellent treatment option, achieving a significant improvement in visual acuity.