title: Surface keratopathy after penetrating keratoplasty.
abstract: OBJECTIVE
  To determine the type and prevalence of epithelial abnormalities in the intermediate postoperative period after penetrating keratoplasty and to define the donor and recipient variables that influence the status of the graft epithelium.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  We prospectively followed the clinical course of 80 patients after penetrating keratoplasty. We monitored the status of the corneal epithelium for 3 months after surgery using slit-lamp biomicroscopy and fluorescein staining of the epithelium. Donor characteristics, recipient preoperative and postoperative variables, and postoperative medications were recorded. Epithelial abnormalities were analyzed against these variables by using univariate and combined statistical models to determine the impact of each variable on postoperative epithelial pathology. Main outcome measures included punctate keratopathy, macro-epithelial defects, hurricane keratopathy, rim defects, and filamentary keratopathy.
  
  
  RESULTS
  Sixty-three percent of all patient visits demonstrated punctate epithelial keratopathy (PEK). Hurricane keratopathy (51%) and filamentary keratopathy (14%) constituted the next most commonly observed abnormalities. Older recipient age and the use of topical antibiotics were associated with a higher prevalence of punctate epithelial keratopathy. The odds ratio (OR) for a 1-year increase in age is 1.0276 (95% CI, 1.1013-1.0442), and the OR for using topical antibiotics is 6.9028 (95% CI, 3.1506-15.1239). Use of topical ofloxacin and increased time after surgery were associated with lower prevalence of punctate keratopathy; ORs were 0.9806 (95% CI, 0.9736-0.9876) and 0.3662 (95% CI, 0.1688-0.7943), respectively. Decreased corneal sensation and the presence of anterior blepharitis preoperatively were associated with an increase in hurricane keratopathy; ORs were 8.8265 (CI, 2.3837-32.6835) and 3.2815 (CI, 1.7388-6.1931), respectively. Total storage time for the donor material was also associated with an increased prevalence of hurricane keratopathy (OR, 1.0316; CI, 1.0052-1.0220). Patients with rim defects and macro-epithelial defects were more likely to have antibiotic and topical lubrication prescribed. No specific variable was found to have a significant association with filamentary keratopathy, except possibly for death-to-preservation time, which had a P value of .0587.
  
  
  CONCLUSIONS
  Surface keratopathy is one of the most common complications of keratoplasty. Our study demonstrates that older age, preoperative lid disease, and decreased preoperative corneal sensation appear to increase the probability of clinically significant epithelial surface abnormalities after keratoplasty. Recognition of these risk factors in advance of surgery will alert the surgeon to the need for appropriate management.
authors.affiliation: Department of Ophthalmology, University of Arkansas Medical School/Harvey, Bernice Jones Eye Institute, USA.
authors.forename: V
authors.initials: V
authors.lastname: Feiz
authors.forename: M J
authors.initials: MJ
authors.lastname: Mannis
authors.forename: G
authors.initials: G
authors.lastname: Kandavel
authors.forename: M
authors.initials: M
authors.lastname: McCarthy
authors.forename: L
authors.initials: L
authors.lastname: Izquierdo
authors.forename: M
authors.initials: M
authors.lastname: Eckert
authors.forename: I R
authors.initials: IR
authors.lastname: Schwab
authors.forename: S
authors.initials: S
authors.lastname: Torabian
authors.forename: J L
authors.initials: JL
authors.lastname: Wang
authors.forename: W
authors.initials: W
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003316:Corneal Diseases / Q000209:etiology*; D019573:Epithelium, Corneal / Q000473:pathology*; D005260:Female; D015590:Fluorophotometry; D005500:Follow-Up Studies; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D014019:Tissue Donors