Penetrating Keratoplasty
The most common indications for PK are combined stromal and endothelial pathology, concomitant intraocular lens (IOL) suturing and anterior segment reconstruction, keratoconus, and, less frequently, endothelial dysfunction (Fig 15-2). Video 15-1 shows PK performed to treat stromal scarring and endothelial decompensation due to congenital hereditary endothelial dystrophy. Video 15-2 shows PK combined with scleral suture fixation of a posterior chamber IOL using an open-sky approach. To educate the patient about the risks and benefits of transplant surgery, the surgeon must understand potential intraoperative and postoperative complications, as well as postoperative management; these are discussed in the following subsections and summarized in Table 15-6.
VIDEO 15-1 Penetrating keratoplasty for stromal scarring and endothelial dysfunction in congenital hereditary endothelial dystrophy.
Courtesy of Robert W. Weisenthal, MD.
Access all Section 8 videos at www.aao.org/bcscvideo_section08.
VIDEO 15-2 PK with scleral-sutured intraocular lens using an open-sky approach.
Courtesy of Robert W. Weisenthal, MD.
Chan CC, Perez MA, Verdier DD, Van Meter WS. Penetrating keratoplasty: the fundamentals. In: Mannis MJ, Holland EJ, eds. Cornea. Vol 2. 4th ed. Philadelphia: Elsevier; 2017:1264–1276.
Intraoperative Complications
Complications that can occur during surgery are listed in Table 15-6.
Chen MC, Mannis MJ. Intraoperative complications of penetrating keratoplasty. In: Mannis MJ, Holland EJ, eds. Cornea. Vol 2. 4th ed. Philadelphia: Elsevier; 2017:1277–1282.
Table 15-6 Comparison of Procedures for Penetrating and Selective Keratoplasty
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.