How is the penetrating keratoplasty surgery performed?

The penetrating keratoplasty surgery is usually performed under local anaesthesia. Through a small corneal incision (opening), the endothelium is removed from the patient’s eye and a disc of donor endothelium is inserted in the patient’s eye which is placed in position with the help of an air bubble.

A few stitches may be taken which will be removed 3-4 weeks after the surgery. Once keratoplasty surgery is over, the patient needs to lie down flat for a few hours for proper attachment of the graft. The air bubble usually gets absorbed in 48 hours but may take longer.

What are the indications of Penetrating Keratoplasty (PDEK)?

Fuch’s endothelial dystrophy
Pseudophakic bullous keratopathy
Aphakic bullous keratopathy
ICE syndrome

Endothelial dysfunction secondary to glaucoma

What are the advantages over full thickness penetrating Keratoplasty?

Few sutures required as compared to penetrating keratoplasty.
Suture induced astigmatism is avoided
Suture related complications are avoided
Greater stability
Faster visual rehabilitation
The graft can be obtained from any age group of the donated eyes
Chances of rejection are less

What are the complications of Penetrating Keratoplasty (PDEK)?

Graft detachment/ dislocation
Recurrent epithelial erosions
Cataract formation
Glaucoma
Graft rejection
Graft failure

What is corneal graft rejection?

The donor eye is genetically different from the patient’s body, due to which the patient’s body tries to fight against it. This is called corneal graft rejection.

What are the symptoms of corneal graft rejection?

The symptoms are: Redness, Sensitivity to light, Vision drop, Pain (RSVP). Along with sticky discharge and foreign body sensation.

Report to your Ophthalmologist as soon as possible if any of the above symptoms show up post-surgery.

How do I prevent graft rejection?

In order to prevent rejection, a list of anti-rejection medications will be prescribed by your doctor, which should be used religiously.
You should have an adequate supply of eyedrops at home so that a single dose is not missed.
Do not stop any medication without consulting your Ophthalmologist.
In case any of the above symptoms of rejection occur, meet your Ophthalmologist immediately. It can often be reversed if anti-rejection medications are started promptly. It should also be noted that rejection can occur at anytime in the years to come.
Review regularly to check for vision, intraocular pressure, graft condition and retinal assessment.

What are the risk factors for rejection?

Vascularisation over the cornea
Pre-existing inflammation
Corneal transplant done more than 2 times
Pre-existing glaucoma

What is graft failure?

When the corneal graft rejection has not been promptly treated or does not respond to anti- rejection medication, graft failure has occurred. The only way of managing graft failure is by replacing the graft. In addition, there are three types of graft rejection: acute, hyperacute, and chronic rejection.

Written by:Dr. Preethi Naveen – Training Committee Chair – Dr. Agarwals Clinical Board

Advanced Corneal Transplant (PDEK)

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