|dc.description.abstract||Purpose: To evaluate the outcome of primary adult optical penetrating keratoplasty
(PKP) at a public health service hospital of a developing country.
Patients and Methods: A retrospective review was performed of the medical records of
every patient 12 years of age or older who underwent PKP for keratoconus, corneal
edema, stromal scarring, or stromal dystrophy at King Khaled Eye Specialist Hospital in
the Kingdom of Saudi Arabia between January 1, 1997, and December 31, 2001, and for
whom a minimum of 3 months’ follow-up was available.
Results: Of 910 eyes that met the inclusion criteria, there were 464 eyes with
keratoconus, 188 eyes with corneal edema, 175 eyes with stromal scarring, and 83 eyes
with stromal dystrophy. For the entire group, the probability of graft survival was 96.7%
at 1 year, 86.2% at 3 years, and 80.9% at 5 years. Five-year survival probability was best
with keratoconus (96.1%), followed by stromal dystrophy (85.9%), stromal scarring
(71.1%), and corneal edema (40.3%). The probability of graft survival differed
significantly among the surgical indications at all postoperative intervals (P<0.001).
Factors associated with a significantly increased risk of graft failure on multivariate Cox
proportional hazard regression analysis included increasing donor tissue age (P = 0.005)
and decreasing recipient graft size (P = 0.02). Final visual acuity of 20/40 or better was
obtained in 409 (44.9%) eyes. Visual acuity of 20/40 or better was obtained in 336
(72.4%) eyes with keratoconus and in 53 (63.9%) eyes with stromal dystrophy but in
only 11 (6.3%) eyes with stromal scarring and 9 (4.8%) eyes with corneal edema
(P<0.001). Overall, improvement in vision occurred in 750 (82.4%) eyes, remained the
same in 97 (10.7%) eyes, and worsened in 63 (6.9%) eyes.
Conclusions: The present study has conclusively demonstrated that primary adult
optical PKP can be performed at a public health facility in the Kingdom of Saudi Arabia
with graft survival and visual results that are comparable to those obtained in welldeveloped
Western facilities. This success is attributed to the presence of a suitable
infrastructure that provides modern eye care facilities, donor tissue, and pharmaceuticals
to patients who have access to preoperative screening and evaluation, surgical
intervention, and postoperative care by well-trained ophthalmologists and ancillary