title: Penetrating Keratoplasty at a Tertiary Referral Center in Ethiopia: Indications and Outcomes.
abstract: OBJECTIVE
  To describe the indications, visual acuity outcomes, and graft survival after penetrating keratoplasty (PKP) in Addis Ababa, Ethiopia.
  
  
  METHODS
  The medical records of patients who underwent PKP at Menelik II Hospital between September 2000 and September 2013 were retrospectively reviewed. The prespecified outcomes were graft survival, visual acuity, and complication rates.
  
  
  RESULTS
  A total of 321 patients underwent PKP during the study period and were included in the analysis. Indications for surgery were trachoma or leukoma in 141 (44%), keratoconus in 45 (14%), corneal dystrophy in 46 (14%), pseudophakic or aphakic bullous keratopathy in 28 (9%), trauma in 27 (8%), previous graft failure in 18 (6%), active ulcer, burn, or perforation in 9 (3%), and others in 7 (2%). The graft survival rate was 80% overall at 2 years but varied considerably depending on the indication for surgery. Uncorrected visual acuity improved from baseline mean logarithm of the minimum angle of resolution 2.09 (SD 0.67) to mean logarithm of the minimum angle of resolution of 1.53 (SD 1.03) at 2 years. A number of factors affected the visual acuity outcomes. Patients were not routinely refracted, and only 18% (N = 60) of patients had access to corrective spectacles or contact lenses postoperatively. Complication rates were high with infectious keratitis being the most common.
  
  
  CONCLUSIONS
  PKP is becoming a viable treatment for corneal opacity in developing countries. However, the high burden of disease and lack of corrective lenses remain significant obstacles to overcome.
authors.affiliation: *Department of Ophthalmology, Addis Ababa University, Addis Ababa, Ethiopia; †Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA; and ‡Department of Ophthalmology, University of California, San Francisco, San Francisco, CA.
authors.forename: Menen
authors.initials: M
authors.lastname: Ayalew
authors.forename: Yonas
authors.initials: Y
authors.lastname: Tilahun
authors.forename: Doug
authors.initials: D
authors.lastname: Holsclaw
authors.forename: Maanasa
authors.initials: M
authors.lastname: Indaram
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Stoller
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Keenan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Rose-Nussbaumer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003318:Corneal Opacity / Q000503:physiopathology / Q000601:surgery*; D003906:Developing Countries; D005002:Ethiopia; D005125:Eye Banks / Q000706:statistics & numerical data; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012017:Referral and Consultation; D012189:Retrospective Studies; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014019:Tissue Donors; D014792:Visual Acuity / Q000502:physiology; D055815:Young Adult