Long-term Outcomes of Penetrating Keratoplasty for Keratoconus With Resolved Corneal Hydrops

Purpose: To address the controversial issue of whether the occurrence of corneal hydrops adversely affects the fate of subsequent penetrating keratoplasty (PK), this study compared the long-term outcomes of PK in keratoconic eyes with resolved corneal hydrops with those without prior corneal hydrops. Methods: This was a retrospective chart review of 102 eyes of 102 patients with keratoconus who underwent PK. The primary outcome measure was endothelial rejection–free allograft survival and the secondary outcomes were vision, postoperative complications, and histopathologic findings of corneal buttons obtained during PK. Results: The mean follow-up after PK was 5.5 ± 3.3 years. The Kaplan–Meier endothelial rejection–free allograft survival at 1 and 5 years post-PK were 93.7% ± 4% and 82.6% ± 7%, respectively, in 32 eyes with hydrops and 100% and 98% ± 2%, respectively, in 70 eyes without hydrops (P = 0.04). Multivariate analysis showed that the risk of endothelial rejection episodes was greater in eyes with longer duration of corneal hydrops (P = 0.019) and coexistent ocular allergy (P = 0.012). All rejection episodes were reversed medically and only 1 allograft failed because of postoperative endophthalmitis. More than 90% of eyes achieved a visual acuity of better than 20/40. Common postoperative complications were cataract and graft infiltrate. Histopathology in cases of resolved hydrops after intracameral gas showed unique compression artifacts like folding and burial of the broken ends of Descemet membrane in the stroma. Conclusions: Although endothelial rejection episodes are more common in eyes with resolved corneal hydrops, long-term allograft survival and visual results after PK in eyes with keratoconus are excellent, irrespective of prior corneal hydrops.

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