Penetrating Keratoplasty at a Tertiary Referral Center in Ethiopia: Indications and Outcomes

Abstract

Purpose To describe the indications, visual acuity outcomes and graft survival after penetrating keratoplasty in Addis Ababa, Ethiopia. Methods The medical records of patients who had penetrating keratoplasty (PKP) at Menelik II Hospital between September 2000 and September 2013 were retrospectively reviewed. The pre-specified outcomes were graft survival, visual acuity, and complication rates. Results A total of 321 patients underwent penetrating keratoplasty during the study period and were included in the analysis. The indications for surgery were trachoma or leukoma in 141 (44%), keratoconus (KCN) in 45 (14%), corneal dystrophy in 46 (14%), pseudophakic or aphakic bullous keratopathy in 28 (9%), trauma in 27 (8%), prior graft failure in 18 (6%), active ulcer, burn or perforation 9 (3%), and other 7 (2%). Graft survival was 80% overall at 2 years but varied considerably depending on indication for surgery. Uncorrected visual acuity improved from baseline mean logMAR 2.09 (SD 0.67) to mean logMAR of 1.53 (SD 1.03) at 2 years. A number of factors affected visual acuity outcomes. Patients were not routinely refracted, and only 18% (N = 60) of patients had access to corrective spectacles or contact lenses post-operatively. Complication rates were high with infectious keratitis being the most common. Conclusions Penetrating keratoplasty is becoming a viable treatment for corneal opacity in developing countries. However, the high burden of disease and lack of corrective lenses remain significant obstacles to overcome.

Modified Tectonic Corneoscleral Graft For Management of Devastating Corneoscleral Infections

“…Previous studies of penetrating keratoplasty for the treatment of infectious keratitis have shown graft survival rates of 78.4%-95.0% [20][21][22]. But few reports have reported graft survival for large-diameter penetrating keratoplasty, which may be related to the rare cases of severe infection.…”

Changing Indications for Penetrating Keratoplasty in Bahrain in a Tertiary Referral Centre

“…To this date, Trachoma remains the most common indication for penetrating keratoplasty in Ethiopia, 11 as the prevalence of active trachoma in some parts of Sub-Saharan Africa is among the highest in the globe. 29 , 30 …”

Full thickness penetrating keratoplasty with cataract extraction and intraocular lens implantation in leprosy patients

“…Graft rejections were higher in cases where the etiology of the corneal opacity was different. [23][24][25] It is important to recognize that a substantial number of PKP will end up with a worse prognosis. This is particularly true when the corneal opacity is large, extending to the limbus and where the vascularization is deep and profuse.…”