Correlation of clinical and pathologic diagnoses of corneal disease in penetrating keratoplasties in Vancouver: A 10-year review

Objectives: The objectives of the present study were: (i) to examine the leading clinical indications and pathologic diagnoses of penetrating keratoplasties in Vancouver, BC; and (ii) to evaluate the correlation between the clinical and pathologic diagnoses. Design: Retrospective chart review of all pathologic records of corneal tissue submitted to the Department of Pathology & Laboratory Medicine, Vancouver General Hospital, during an 11-year period. Methods: For each penetrating keratoplasty, information regarding the clinical indication and pathologic features identified on histopathologic analysis was compiled. Results: The top 5 clinical indications for transplant were failed graft (21%); bullous keratopathy (20%); keratoconus (17%); scarring, with or without inflammation (14%); and Fuchs dystrophy (11%). The top 5 pathologic diagnoses corresponded to these clinical diagnoses. In the majority of cases, there was agreement between clinical and pathologic diagnoses; however, in 6% of records, the clinical and pathologic diagnoses did not correlate. This situation occurred most often when considering grafts with clinical diagnoses of bullous keratopathy, Fuchs dystrophy, or keratoconus. A review of the grafts with infectious keratitis illustrated the potential for histopathologic evaluation of corneal buttons to identify unsuspected infectious agents. Conclusion: Routine histopathologic evaluation of penetrating keratoplasty clarifies the clinical diagnosis in a proportion of cases and aids in identifying infectious agents.