Factors associated with the need for penetrating keratoplasty in keratoconus

Purpose. This study was designed to identify factors that may help to determine the likelihood of a patient with keratoconus undergoing a penetrating keratoplasty (PK) after referral to a cornea service. Methods. A retrospective chart review of 109 patients from a corneal referral practice was undertaken to identify clinical characteristics at presentation that were predictive of subsequent PK. Results. Overall, during an average follow-up of 10.9 years, 39 (35.8%) did not have a PK for keratoconus in either eye, 34 (31.2%) had a PK in one eye, and 36 (33.0%) had a PK in both eyes. The presence of corneal scarring and steep keratometry values were significant risk factors for subsequent PK. Conclusion. In a corneal referral practice, 64.2% of patients go on to PK in one or both eyes during long-term follow-up. The presence of scarring and high keratometry values at initial presentation may help to predict the likelihood of requiring a PK and may aid in patient counseling.