Abstract
Introduction In severe corneal infections or keratolysis, large-diameter penetrating keratoplasty (LDPK) is often the last resort before eye evisceration or enucleation to restore tectonic integrity. The literature shows a greater risk of complications postoperatively, second surgeries, and poor visual acuity following a large-diameter keratoplasty. Studies overlook LDPK benefits, such as maintaining eye integrity and limited vision.
Methods We performed a retrospective observational study of all full-thickness corneal grafts at Southampton General Hospital from 2017 to 2022 with graft diameters larger than 8.5 mm. Data from these patients were analysed for tectonic success, visual outcomes, and graft rejection/failure rate.
Results 18 patients underwent large-diameter penetrating keratoplasties from 2017 to 2022. Of these, 12 cases (66.7%) were performed for severe infectious keratolysis and 4 (22.2%) for perforation from pellucid marginal degeneration and trauma. Tectonic stability was achieved in 15 cases (83.3%) at a mean follow-up of 26.05 months. Optical outcomes showed improvement in visual acuity in 10 patients (55.6%). Graft remained clear in 9 out of 15 cases (60%) where a tectonic outcome was achieved.
Conclusion/Discussion LDPK should be considered as an option in corneal infection and keratolysis cases to avoid enucleation or evisceration. Our study found that 83.3% of cases achieved this goal. However, the prognosis for vision and graft viability remains guarded, and patients should be counselled accordingly.
