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Penetrating Keratoplasty for Trachomatous Corneal Scarring

Purpose: To evaluate graft survival and visual outcome after penetrating keratoplasty (PKP) for trachomatous corneal scarring. Methods: A retrospective review was conducted on all cases of PKP performed at King Khaled Eye Specialist Hospital between January 1, 1997, and December 31, 2001, for trachomatous corneal scarring. Results: This study included 127 eyes. The mean age at the time of surgery was 64.7 years (range, 40-90 years). The mean follow-up was 1266 days (range, 91-3423 days). At the most recent visit, 102 (80.2%) grafts were clear, and 25 (19.7%) had failed. Kaplan-Meier graft survival was 98.3% at 1 year, 85.9% at 2 years, 83.2% at 3 years, 80.2% at 4 years, and 76.6% at 5 years. Major postoperative complications included worsening of glaucoma (27.6%), endothelial rejection (17.3%), and bacterial keratitis (8.7%). Visual acuity improved in 107 (84.3%) eyes, remained the same in 12 (9.5%) eyes, and worsened in 8 (6.3%) eyes. Final visual acuity of 20/160 or better was obtained in 67 (56.7%) eyes. Conclusions: Treating trachomatous corneal scarring with PKP can be associated with a good prognosis for graft survival and improved vision in carefully selected cases with mild or well-controlled ocular surface disease and absent or previously surgically corrected eyelid abnormalities.