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Outcomes of Penetrating Keratoplasty in Keratoconus

Javadi, Mohammad Ali MD*; Motlagh, Behzad Fallahi MD; Jafarinasab, Mohammad Reza MD*; Rabbanikhah, Zahra MD§; Anissian, Arash MD§; Souri, Hamid PhD; Yazdani, Shahin MD*

doi: 10.1097/
Clinical Sciences

Purpose: Keratoconus (KCN) is one of the most common indications of corneal transplantation in Iran. This study was conducted to determine the outcomes of penetrating keratoplasty (PK) for KCN in patients operated in a private practice setting from 1994 to 2001.

Methods: This longitudinal retrospective study included 164 eyes of 164 patients. Variables included preoperative keratometry, trephination and suturing techniques, donor-recipient disparity, surgical complications, immunologic rejection, graft clarity, postoperative spherical and cylindrical refractive error, keratometry, uncorrected and best spectacle-corrected visual acuity, suture management, and the results of keratorefractive procedures.

Results: Patients were followed for a mean period of 33.5 months. Mean postoperative best spectacle-corrected visual acuity (BSCVA) at last follow-up was 0.14 ± 0.11 LogMAR (20/25); mean spherical error and mean corneal astigmatism were −0.61 ± 2.6 and 3.4 ± 1.8 D, respectively. Final visual outcomes were not significantly correlated with trephination and suturing techniques or severity of the ectasia. Although donor-recipient disparity did not affect final astigmatism, more myopic shift was observed with greater disparity, but this finding was not of statistical significance. Overall, 26.8% of the patients required keratorefractive surgery, which resulted in 2.9 D reduction in corneal astigmatism. Immunologic graft rejection occurred in 28% of cases; however, all episodes responded to medical management, and none resulted in graft failure.

Conclusion: Penetrating keratoplasty is a safe and effective procedure with remarkable optical and visual outcomes for patients with keratoconus who are contact lens intolerant or have unacceptable corrected visual acuity. Neither severity of the disorder nor trephination and suturing techniques significantly affects final visual outcomes. Less graft-recipient disparity (0.25 versus 0.50 mm) seems to induce less myopic shift.

From the *Department of Ophthalmology, Shaheed Beheshti University of Medical Sciences, Tehran, Iran; †Department of Ophthalmology, Tabriz University of Medical Sciences, Tabriz, Iran; §Ophthalmology Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran; and ‡Department of Epidemiology, Ahwaz University of Medical Sciences, Ahwaz, Iran.

Received for publication July 21, 2004; revision received January 5, 2005; accepted January 15, 2005.

Reprints: Mohammad Ali Javadi, MD, Ophthalmic Research Center, Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Boostan 9 Street Pasdaran Avenue, Tehran 16666, Iran (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.