title: Indications for and outcomes of penetrating keratoplasty performed by resident surgeons.
abstract: OBJECTIVE
  To analyze the indications for and outcomes of penetrating keratoplasty (PKP) performed by resident surgeons at both county hospital and Veterans Affairs facilities.
  
  
  METHODS
  Observational case series.
  
  
  METHODS
  Retrospective review of 79 eyes from 61 patients undergoing PKP from January 1, 1997, through December 31, 2001, to determine indications for surgery and outcomes, including graft clarity and final visual acuity.
  
  
  RESULTS
  There were 52 (65.8%) primary and 27 (34.2%) repeat transplants performed. Follow-up after surgery averaged 21.9 months. Indications for PKP included failed graft, 23 (29.1%), bullous keratopathy, 17 (21.5%), keratoconus, 16 (20.3%), corneal scar, 15 (19.0%), corneal perforation from infection, 5 (6.3%), and Fuchs endothelial dystrophy, 3 (3.8%). Twenty-one eyes had pre-existing ocular disease limiting final acuity. Overall, 51 grafts (64.6%) remained clear. More primary than repeat grafts remained clear (75% vs 44.4%, P =.012) and achieved 20/40 or better final acuity (30.8% vs 11.8%, P =.05). Excluding failed grafts or eyes with limited visual potential, final acuities achieved were: 19 (47.5%) 20/40 or better, 18 (45%) 20/50 to 20/150, 3 (7.5%) 20/200 or worse. Grafts remaining clear by indication were: failed graft, 9 (39.1%); keratoconus, 14 (87.5%); bullous keratopathy, 13 (76.5%); corneal scar, 10 (66.7%); corneal perforation, 2 (40%); Fuchs, 3 (100%). Eyes achieving final acuity of 20/40 or better by indication were: keratoconus, 9 (56.2%); failed graft, 3 (13%); bullous keratopathy, 3 (17.7%); corneal scar, 2 (13.3%); corneal perforation, 0 (0%); Fuchs, 2 (66.7%).
  
  
  CONCLUSIONS
  County hospital and Veterans Affairs facilities provide a challenging subset of patients for penetrating keratoplasty. Failed graft was the leading indication for transplantation for our population. Graft clarity and final visual acuity varied by indication for transplantation. Resident surgeons can achieve favorable results for penetrating keratoplasty performed at these venues, especially for primary transplants.
authors.affiliation: Emory University, Department of Ophthalmology, Atlanta, Georgia 30322, USA. Jrandle@emory.edu
authors.forename: J Bradley
authors.initials: JB
authors.lastname: Randleman
authors.forename: C Diane
authors.initials: CD
authors.lastname: Song
authors.forename: David A
authors.initials: DA
authors.lastname: Palay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003315:Cornea / Q000502:physiology; D003316:Corneal Diseases / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000601:surgery*; D006085:Graft Survival / Q000502:physiology; D006766:Hospitals, County / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D015948:Keratoplasty, Penetrating / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000193:education*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology