Indications and outcomes of penetrating keratoplasty in a tertiary hospital in the developing world

Background: To assess the indications for and graft outcomes of penetrating keratoplasty (PK) in a tertiary hospital in China. Design: A retrospective analysis of hospital records of patients, who had undergone PK at the First Affiliated Hospital of Zhejiang University in China over a 10-year period, was performed. Participants: A total of 203 eyes met the inclusion criteria for this study. Methods: All PKs were performed with a standard technique throughout. Main Outcome Measures: Outcome measures included best corrected visual acuity at last follow-up, and overall graft survival. Data were assessed by Kaplan-Meier survival methods, univariate analysis and multivariate cox proportional hazards regression modelling. Results: Among 203 eyes included in this study, the most common indications for PK in this study group were corneal scar caused by herpes simplex keratitis (24.1%) and trauma (mechanical and chemical) (21.2%). At the last follow-up, significantly more patients (35.0%) achieved 20/40 or better after PK compared with preoperation (P<0.05). Overall, the 2-year graft survival rate was 79.9±3.6%. In a univariate analysis, gender, indications for PK, type of operative procedure, rejection episode, postoperative glaucoma and postoperative herpetic recurrence were shown to be significantly associated with graft survival. In a multivariate analysis, three independent predictors of graft failure were identified including indications, gender and rejection episode. Conclusions: PK is effectively performed to improve visual function in southeast China. The outcomes of this study concur with other published studies and can be used as prognostic guidelines for any tertiary hospital in developing world.