Analysis of causes for penetrating keratoplasty at Shandong Eye Institute from 1997 to 2002

Abstract

To examine the major causes and identify trends of penetrating keratoplasties (PKPs) performed in Shandong Eye Institute in the past 6 years. The patients who received PKP in Shandong Eye Institute between January 1, 1997 and December 31, 2002 were reviewed retrospectively. The causes were classified into 10 different groups: purulent keratitis, herpes simplex keratitis (HSK), keratoconus, bullous keratopathy, corneal scar, corneal trauma, corneal burn, regraft, corneal dystrophy and degeneration, and others. The trend of changes in causes was analyzed. Purulent keratitis was further classified according to the pathogens. The initial diagnosis and causes of regrafting were noted, as well as the intraocular surgeries related to bullous keratopathy. A total of 1702 cases were included in this study. The leading indications for PKP, in order of decreasing frequency, were purulent keratitis (31.9%), HSK (17.6%), keratoconus (12.9%), corneal scar (9.6%), bullous keratopathy (6.9%), penetrating corneal trauma (6.2%), regraft (4.5%), thermal and chemical burn (4.1%), corneal dystrophy and degeneration (3.9%) and others (2.4%). An increasing trend in keratoconus (chi(2) = 26.399, P < 0.001) and bullous keratopathy (chi(2) = 11.4229, P < 0.001) was noted, but not in the others. Fungi were the most common pathogens of purulent keratitis (65.9%). No changes were found in the pathogens of purulent keratitis during the past 6 years. Most of bullous keratopathy had a history of cataract operation (76.3%). Ocular burn (24.7%), HSK (23.4%) and purulent keratitis (14.3%) were the three primary affections of regraft. The main causes of graft failure that lead to the regraft were immune rejection (61.0%), grafts infection (14.3%) and HSK recurrence (10.4%). Infectious keratopathy is still the leading indication for PKP. Among the infectious keratitis, fungal infection is the top cause of PKP. Keratoconus and bullous keratopathy have shown an increasing trend.