Anatomical And Functional Success Of Tectonic Penetrating Keratoplasty In A Tertiary Eye Clinic

To determine the anatomical and visual results of tectonic penetrating keratoplasty (PK) performed for  corneal disorders threatening globe integrity in a tertiary eye clinic.

Corneal perforation is a serious emergency condition, with complications including cataract, endophthalmitis, and globe loss.  Large perforations and meltings often require tectonic PK which is performed under suboptimal conditions due to its urgency. The primary goal of this treatment is to restore ocular integrity.So the anatomical alignment of graft and host and the surgery’s visual and functional results are always a debate of wonder.

The clinical records of 19  eyes of 19 patients  which underwent tectonic penetrating keratoplasty (PK) in Basaksehir Cam Sakura City Hospital between 2021-2023 were retrospectively reviewed.  The primary indications for surgery were as follows: neurotrophic keratitis (6 eyes, 31.6%), infectious keratitis (6 eyes, 31.6%), chemical injury/burn (2 eyes, 10.5%), trauma (1 eye, 5.3%), rheumatologic disease (3 eyes, 15.8%), exposure keratopathy (1 eye, 5.3%). Results were evaluated for each criterion: anatomical integrity of the eye, postoperative treatment modalities, complications, anterior segment OCT and corneal topography parameters, graft clarity, and visual acuity.

The mean age of patients was 56.9 years.The mean postoperative follow-up period was 15 months (min 3, max 40).Anatomical integrity was achieved for 17 out of 19 eyes  (89%).8 eyes had no rejection reaction (42.1%) whereas 9 eyes developed graft rejection (47.4%).Only topical prednisolone was sufficient for 11 patients (57.9%) but systemic immunosuppressive therapy was added to topical regimen for 8 patients (42.1%).Epithelialization was achieved with topical artificial tears in 7 patients (36.8%), whereas amniotic membrane transplantation was performed in 12 patients (63.2%).Graft-host junction alignment was achieved in 12 patients (63.2%) where as steps were observed in 6 patients (31.6%).

Although it is performed under suboptimal and urgent conditions; tectonic penetrating keratoplasty provides anatomical success and is a beneficial procedure for restoring the cornea in cases where infection does not resolve or the corneal integrity is disrupted.