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Aims: To determine the indications for penetrating keratoplasty (PK) at the Corneoplastic Unit and Eye Bank, UK, a tertiary referral centre, over a 10 year period. Methods: Records of all patients who underwent PK at our institution between 1990 and 1999 were reviewed retrospectively. Of the 1096 procedures performed in this period, 784 records were available for evaluation (72%). Results: Regrafting was the most common indication, accounting for 40.9% of all cases. Keratoconus was the second most common indication (15%), followed by Fuchs' endothelial dystrophy (9.3%), pseudophakic bullous keratopathy (7.6%), and viral keratitis (5.9%), which included both herpes simplex and herpes zoster and showed a statistically significant decreasing trend using regression analysis (p,0.005). Among the regraft subgroup, viral keratitis accounted for 21.2% as the underlying primary diagnosis. The most common cause for graft failure in the regraft subgroup was endothelial failure (41.8%). Conclusion: Regrafting is the leading indication for PK; viral disease-although declining-is the leading primary diagnosis. P enetrating keratoplasty (PK) is the most common tissue transplant performed in Europe and the United States. Advances in the medical management of certain diagnoses and the adoption of a conservative approach have changed patterns in the indications of PK. Moreover, the decline of certain disorders due to changes in surgical practice, and the emergence of new surgical techniques have largely influenced the changing trend. The indications for PK have continued to change since 1940, 1-3 and investigators have studied the changing trends over the past few decades. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] To update these trends we report the indications for PK from 1990 to 1999, and compare these with indications during an earlier time period at the same institution 4 and to those of other series. PATIENTS AND METHODSA retrospective analysis of records of all cases of PK performed between January 1990 and December 1999 was undertaken. All cases were performed at the Corneoplastic Unit and Eye Bank, UK, a tertiary referral centre for corneal and anterior segment disorders. Of the 1097 PKs performed in this period, only 784 medical records were available for review. Records were not accessible or had been destroyed as patients had not been followed up-either because they lived abroad, transferred to another institution, or had died. Although the indications for PK for the remaining 313 cases could be retrieved from the booking register, we elected not to include these as there was little correlation between the data recorded in the operative note and the register. Information obtained was analysed with respect to age, sex, eye grafted, and preoperative clinical diagnosis. The indications for PK were divided into seven diagnostic categories (fig 1). Regrafts were further analysed for the aetiology of failure of the previous graft and original diagnosis.Statistical significance was determined using ...

Purpose To evaluate the safety and efficacy of surgical implantation of prosthetic iris devices in patients with iris deficiency. Methods Nine patients with traumatic iris defects, congenital aniridia or iris coloboma, and surgical or optical iridectomies were included in a noncomparative case series. Cataract surgery with intraocular lens and prosthetic iris implantation was performed in 10 eyes. The visual acuity, subjective degree of glare disability, postoperative anatomic results, and intraoperative and postoperative complications were evaluated. Results The mean follow-up was 17.75 months (range 4-48 months). Best-corrected visual acuity improved in nine of 10 eyes (90%) and remained unchanged in one eye. Glare subjectively improved in four of five eyes (80%) of patients complaining of glare preoperatively. All eyes achieved the desired anatomic result. Intraoperative complications included one anterior capsular tear. Postoperative complications included a short period of mild postoperative anterior uveitis in four eyes. Secondary glaucoma was absent. Conclusion In patients with iris deficiency, implantation of prosthetic iris device, and intraocular lens implant following cataract surgery appears to be safe and effective in reducing glare disability and improving visual outcomes.

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Penetrating keratoplasty is a safe and effective treatment for selected corneal disorders. Penetrating keratoplasty for viral keratitis may achieve good results with long term antiviral treatment. Patients may achieve better outcomes if their surgery is performed at specialist centres.