Penetrating keratoplasty for corneal perforations in fungal keratitis

PURPOSE: To evaluate the complications and therapeutic effects of penetrating keratoplasty (PKP) in the treatment of corneal perforations in fungal keratitis. METHODS: The medical records of patients who underwent PKP for corneal perforations in fungal keratitis at Shandong Eye Institute from January 1999 to December 2004 were retrospectively reviewed. RESULTS: Fifty-two patients (52 eyes) were included in this study. Twenty eyes (38.5%) had graft rejection after primary PKP, 12 of which were medically treated, and 8 underwent secondary PKP with 4 acquiring clear grafts. Fungal infection recurred in 8 eyes (15.4%), 3 of which were controlled with antifungal agents, 3 were treated with secondary PKP, and 2 were enucleated. Ten eyes (19.2%) with complicated cataract underwent intraoperative or postoperative extracapsular cataract extraction. Seven eyes (13.5%) with secondary glaucoma were cured. Graft ulcer occurred in 5 eyes (9.6%), 3 of which were cured with amniotic membrane transplantation and 2 with medications. Forty-four grafts (84.6%) remained clear at final follow-up, and 46 eyes (88.5%) had improved visual acuity. CONCLUSION: Although many complications may occur, therapeutic PKP seems to be effective in the treatment of fungal keratitis with corneal perforation.