To quantify all minor/major adverse events
in a large cohort of consecutive corneal transplants, particularly in respect to penetrating keratoplasty (PKP).
All corneal transplants in the Auckland region over a 10-year period (2000–2009) were identified through the New Zealand National Eye Bank. Relevant clinical records were assessed for this period and 2 years after. All intraoperative or postoperative adverse events
/complications, visual acuity
, and graft outcomes were recorded.
Detailed data were available for 941 (94.5%) of 996 procedures in the study period, including 834 PKPs, 73 deep anterior lamellar keratoplasties, 28 Descemet stripping endothelial keratoplasties, and 6 tectonic keratoplasties. Intraoperative adverse events
occurred in 117 (12.4%) procedures, most commonly positive vitreous pressure (6.3%). Postoperative adverse events
included elevated intraocular pressure (21.3%, >30 mm Hg), graft rejection
(29.8%), suture-related complications (30.1%), dry eye (15.9%), epithelial defect (9.8%), wound compromise (3.4%), microbial keratitis (3.2%), and endophthalmitis (0.6%). At 2 years, 58.7% of eyes achieved best-corrected visual acuity
of ≥6/12 (20/40) and 69.6% achieved ≥6/18 (20/60). Graft survival at 2 years was 87.9%, 92.3%, and 100% for PKP, deep anterior lamellar keratoplasty, and Descemet stripping endothelial keratoplasty, respectively.
In this study of 941 consecutive, principally penetrating, corneal transplants, adverse events
were found to be more common than typically reported. In an era in which PKP is increasingly substituted by lamellar surgery, this provides useful insight into operative and postoperative adverse events
in penetrating surgery.