Large Diameter Penetrating Keratoplasty for Infectious Keratitis
To report the outcomes of large diameter penetrating keratoplasty (LDPK) performed for infectious keratitis and investigate factors influencing graft survival and visual outcome.
A retrospective chart review was performed for all eyes that underwent LDPK (defined as 10 mm or greater) for infectious keratitis at The New York Eye and Ear Infirmary from January 2004 to December 2014. Outcome measures included visual acuity, complications, and graft failure rates. Regression analysis and a one-way analysis of variance were used to assess predictors of final best-corrected visual acuity (BCVA) and development of graft failure.
Forty-two eyes of 42 patients with infectious keratitis that underwent LDPK (range 10-16 mm) were included. In 36 of 42 eyes (86%), infection was eradicated following the large diameter keratoplasty. Thirty-six eyes (86%) retained structural integrity and 30 (71%) ultimately had clear grafts or stable keratoprosthesis. Thirty (71%) eyes had improved BCVA with 16 (38%) achieving 20/50 or better. Presenting BCVA was predictive of final BCVA (p= 0.0026). Visual outcomes varied by infectious etiology (p=0.01), with acanthamoeba having the best visual outcome and fungal having the worst visual outcome. Graft size did not significantly influence final BCVA.
Large diameter penetrating keratoplasty for severe infectious keratitis can have favorable long-term visual outcomes. Visual outcomes are influenced by presenting visual acuity and infectious etiology, without significant influence from graft size or need for repeat keratoplasty.