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Penetrating Keratoplasty and Complications Management

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Albert and Jakobiec's Principles and Practice of Ophthalmology

Abstract

The most common clinical indications for penetrating keratoplasty in the USA and Canada are keratoconus, repeat graft, and pseudophakic bullous keratopathy. The factor most commonly associated with an increased risk of allograft rejection is corneal vascularization. The role of pathologic lymphatic channels in allograft rejection is increasingly recognized. Any suture that is broken, loose, or associated with stromal vascularization across the wound should be removed immediately to lower the risk of rejection. Intensive topical steroid treatment should immediately be commenced for newly documented corneal graft failures. The success rate of rejection treatment is usually 50–60%. Increasing corneal thickness measured by pachymetry is a very useful way to document progressing graft failure. Refractive unpredictability after penetrating keratoplasty is extremely common with most series documenting mean cylinder of 4–5 diopters and significant anisometropia. Options for managing postoperative astigmatism include limbal relaxing incisions, laser refractive surgery, and toric and artisan toric intraocular lens insertion.

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Authors and Affiliations

  1. Royal Victoria Eye and Ear, Dublin, Ireland

    Barry J. Power & William J. Power

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  1. Barry J. Power
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Correspondence to Barry J. Power .

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Editors and Affiliations

  1. Casey Eye Institute, Oregon Health & Science, Portland, OR, USA

    Daniel M. Albert

  2. Department of Ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joan W. Miller

  3. Department of Ophthalmology, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  4. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

Section Editor information

  1. Department of Ophthalmology, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  2. Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA

    Mark I. Rosenblatt

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Power, B.J., Power, W.J. (2022). Penetrating Keratoplasty and Complications Management. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_220

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