Longterm follow-up of penetrating keratoplasty for keratoconus

Purpose: This study aims to describe the current visual and refractive status of patients who underwent penetrating keratoplasty (PK) for keratoconus > 20 years ago and to report on the current status of their grafts. Methods: A total of 138 eyes in 103 patients were grafted for keratoconus between August 1968 and December 1985. Patients who had not undergone retransplantation were invited to attend a clinical examination. Forty-eight patients (with 61 grafts) accepted the invitation and were examined. Results: The average length of time since PK was 26.9 years (standard deviation [SD] 4.2 years, range 20.8-38.0 years, n = 61). The average graft age at examination was 82.1 years (SD 19.9 years, range 41-115 years). A total of 80% (49 of 61 grafts) of the examined eyes had a clear graft and 46% (28 of 61 eyes) had best spectacle-corrected visual acuity (BSCVA) >= 0.5. The mean endothelial cell density per mm2 was 894 (SD 4.6, range 470-1775). The mean central corneal thickness of the clear grafts was 0.565 mm (SD 0.048 mm). Conclusions: Penetrating keratoplasty for keratoconus has a good longterm prognosis; half of the eyes examined in this study had BSCVA >= 0.5 at > 20 years after surgery.