Therapeutic Penetrating Keratoplasty.

Abstract

To the Editor: I read with interest the article by Roozbahani et al.1 The authors present an interesting study that report the findings of eyes undergoing therapeutic penetrating keratoplasty (Th PK) because of a corneal perforation, impending corneal perforation or recalcitrant infection in patients with infectious keratitis. Although the authors highlight the fact that the main objective with Th PK is to reestablish the integrity of the globe, many times in an urgent setting, the excellent results leading them to conclude that this procedure achieves corneal clarity and improves vision in most patients have to be taken to caution, specially in some scenarios. There is a considerable shortage of corneal graft tissue worldwide, with an important percentage of world’s population having no access to corneal transplantation.2 In some countries, although this effort is constantly made, the access to corneal tissue is still difficult; the corneal tissue without an optical quality, due to a low endothelial cell count, or inadequate corneal excision technique, is sometimes stored to be used in ophthalmic emergencies. These issues generate lower chances of improvement in corneal clarity at follow-up. In addition to that, the presence of aggressive pathogenic organisms may lead to different complications as mentioned by the authors, including cataract, glaucoma, or graft failure.1 In a previous series of nontraumatic corneal perforations presented by us, the infectious etiology group had a worst visual acuity at presentation (median logMAR 3.0, interquartile range [IQR] of 1.91–4), and also, a worst visual acuity at final consultation (median 3.0, IQR 1.18 to 3), with most of the patients in this group being treated with Th PK.3 Another important issue not mentioned is the possibility of an infection recurrence, being important in all bacterial, viral, and fungal keratitis, deserving attention and continued treatment.3,4 Finally, I emphasize the value of this article in supporting the use of Th PK in the treatment of corneal perforations.