Clinical outcome of first hundred consecutive therapeutic penetrating keratoplasties done at a tertiary eye care centre in Eastern India

Aim: To analyze the clinical outcome of first 100 consecutive cases of therapeutic penetrating keratoplasty (TPK) done at a tertiary eye care centre in Eastern India. Materials and Methods: A retrospective analytical observational study of first 100 consecutive patients of TPK was done at RIO, IGIMS, Patna, Bihar for nonhealing keratitis with or without perforation with a minimum 1 year follow up examination. Patients with vitreous exudates were excluded from the study. Results: Organisms were isolated in 60% of cases of which 65% were fungi (Aspergillus), 20% were bacteria, (Staphylococcus aureus) and 15% had mixed infection. 17 cases required lens removal during surgery. Repeat graft infection was noticed in 23 cases of which 9 had fungi, 2 had bacterial isolate and rest was inconclusive preoperatively. A repeat TPK was performed in 7 patients out of the reinfected cases. Anatomical restoration could be achieved in 96% of cases. Graft clarity allowing clear view of anterior chamber could be seen in 26 cases. 4 cases of graft infection with posterior segment involvement finally required evisceration. 47 out of 100 TPK cases had raised intraocular pressure (IOP) of which 10 underwent glaucoma surgery for uncontrolled IOP despite medications. Conclusion: TPK is a challenging surgery still having definite role in management of nonresponding progressive keratitis. Maintaining graft clarity postoperatively is a difficult task in these cases therefore success should be measured in terms of infection eradication and anatomical restoration.