Correlation of clinical and pathologic diagnoses of corneal disease in penetrating keratoplasties in Vancouver: a 10-year review.

OBJECTIVES

The objectives of the present study were: (i) to examine the leading clinical indications and pathologic diagnoses of penetrating keratoplasties in Vancouver, BC; and (ii) to evaluate the correlation between the clinical and pathologic diagnoses.

DESIGN

Retrospective chart review of all pathologic records of corneal tissue submitted to the Department of Pathology & Laboratory Medicine, Vancouver General Hospital, during an 11-year period.

METHODS

For each penetrating keratoplasty, information regarding the clinical indication and pathologic features identified on histopathologic analysis was compiled.

RESULTS

The top 5 clinical indications for transplant were failed graft (21%); bullous keratopathy (20%); keratoconus (17%); scarring, with or without inflammation (14%); and Fuchs dystrophy (11%). The top 5 pathologic diagnoses corresponded to these clinical diagnoses. In the majority of cases, there was agreement between clinical and pathologic diagnoses; however, in 6% of records, the clinical and pathologic diagnoses did not correlate. This situation occurred most often when considering grafts with clinical diagnoses of bullous keratopathy, Fuchs dystrophy, or keratoconus. A review of the grafts with infectious keratitis illustrated the potential for histopathologic evaluation of corneal buttons to identify unsuspected infectious agents.

CONCLUSION

Routine histopathologic evaluation of penetrating keratoplasty clarifies the clinical diagnosis in a proportion of cases and aids in identifying infectious agents.