Outcomes of Therapeutic and Tectonic Penetrating Keratoplasty for Advanced Corneal Disease.

PURPOSE: To evaluate graft survival, clinical outcomes, and prognostic factors after therapeutic and tectonic penetrating keratoplasty (PKP) in a tertiary eye care center in Saudi Arabia.

METHODS

This retrospective study analyzed the medical records of all patients who underwent therapeutic or tectonic PKP between June 2014 and December 2020 at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. Inclusion criteria required at least a two-year follow-up for clear grafts. Data collected included demographics, preoperative characteristics, surgical details, postoperative visual acuity, graft survival, and complications. Kaplan-Meier survival analysis was performed, and risk factors for graft failure were evaluated.

RESULTS

Ninety eyes from 90 patients met the inclusion criteria. The mean age was 52.0 ± 23.5 years, and 55.5% of patients were male. The mean follow-up was 3.8 ± 1.2 years (range 2.1-6.4 years). The most common indication was microbial keratitis (76.7%), followed by autoimmune disease (8.9%) and trauma (5.6%). The mean donor graft size was 8.91 ± 1.67 mm. Kaplan-Meier cumulative graft survival was 48.2% at 1 year, 27.8% at 2 years, and 24.4% at 3 and 4 years. Larger graft size was the only significant risk factor for graft failure (p < 0.001). The most common complications were glaucoma (46.6%), persistent epithelial defect (37.8%), and persistent infection (31.0%). Visual acuity improved in 10.0%, remained stable in 75.6%, and deteriorated in 14.4% of cases.

CONCLUSION

Therapeutic and tectonic PKP preserved globe integrity in most eyes but were associated with poor graft survival, limited visual recovery, and frequent postoperative complications in this high-risk cohort. These findings are consistent with presentation at an advanced stage of disease in a tertiary referral setting, as reflected by large graft size and poor baseline visual acuity.