Total Penetrating Keratoplasty: Indications, Therapeutic Approach, and Long-Term Follow-Up.

Purpose: Evaluation of the indications, anatomical and functional results, and complications of total penetrating keratoplasty (TPK) in disorders involving whole cornea.

Materials and Methods: We analyzed outcomes of the surgical treatment of 47 eyes of 46 patients that underwent TPK. Indications were infectious keratitis, autoimmune disease, injury of the eyeball (mainly chemical burns), and other combined disorders. The surgical technique involved dissection of affected tissues with a margin of 1.0 mm. The size of the corneal graft ranged from 10.0 to 14.0 mm. We analyzed indications, outcomes, and complications of surgery.

Results: Final restoration of the ocular integrity and maintenance of the globe were achieved in 27 eyes (57%). More than one surgery was necessary in a total of 29 eyes (62%). The frequency of retransplantations did not vary significantly between the groups with different causes of corneal melting/perforation (63% of eyes with infection, 66% of eyes after trauma and 70% of eyes of patients with autoimmune disorders). Surgical treatment failed in 20 eyes (43%). Evisceration was necessary in 13 eyes (28%), phthisis occurred in 7 cases (15%).

Conclusion: TPK should be considered as a last line treatment in huge corneal destruction to restore integrity of the eye globe.