title: Bilateral penetrating keratoplasty--indications, results and review of literature.
abstract: OBJECTIVE
  To analyze the indications, functional results, and rates of graft rejection and failure after bilateral penetrating keratoplasty (PK) in a major eye care hospital and research center in India.
  
  
  METHODS
  Retrospective review of the case records of 38 patients who underwent bilateral PK and had at least 6 months follow-up after corneal transplantation in the second eye.
  
  
  RESULTS
  The mean age of the 38 patients (20 M, 18 F) was 35 +/- 25 years (range, 0.5 to 79 years). Mean follow-up was 49 +/- 23 months (range, 13.4 to 116.4 months) after surgery in the first eye and 31 +/- 22 months (range, 6.6 to 103.6 months) after surgery in the second eye. The average time interval between surgery in the first and second eye was 18 +/- 10 months (range, 0 to 38 months). The commonest indications for surgery were corneal dystrophies (50%), aphakic bullous keratopathy (21%), and keratoconus (11%). Postoperatively, secondary glaucoma occurred in 2 first and 3 second eyes. Best-corrected visual acuity at last follow-up was > 6/12 in 34% of first eyes and 50% of second eyes, and was < 6/60 in 26% and 18% of first and second eyes respectively. Allograft rejection occurred in 4 of the first eyes and 3 of the second eyes. The two-year graft survival rate in first eyes was 70% and in second eyes was 83%. Worse outcomes were noted in grafts performed for secondary endothelial failure. Earlier graft failure occurred in first eyes (54 +/- 5 months) compared to second eyes (79 +/- 10 months) (Logrank Test p = 0.2311).
  
  
  CONCLUSIONS
  Bilateral penetrating keratoplasty has reasonable success in selected patients. Corneal transplantation in the second eye does not seem to increase the risk of graft rejection in either eye.
authors.affiliation: Sankara Nethralaya, Medical Research Foundation, Chennai, Tamil Nadu, India. mrf@sankaranethralaya.org
authors.forename: S K
authors.initials: SK
authors.lastname: Rao
authors.forename: R R
authors.initials: RR
authors.lastname: Sudhir
authors.forename: R
authors.initials: R
authors.lastname: Fogla
authors.forename: R
authors.initials: R
authors.lastname: Rajagopal
authors.forename: G
authors.initials: G
authors.lastname: Sitalakshmi
authors.forename: P
authors.initials: P
authors.lastname: Padmanabhan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003316:Corneal Diseases / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis; D006801:Humans; D007223:Infant; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014792:Visual Acuity