Enhanced Surgical Safety through Protective Penetrating Keratoplasty: A Retrospective Analysis of 22 Cases

Context. Penetrating keratoplasty (PK) is a recognized treatment for corneal damage but possesses inherent risks, mainly due to its open-sky nature, which potentially lead to severe sight-threatening complications. Protective penetrating keratoplasty (PPK) emerges as a novel procedure aimed at mitigating these risks. Aim. To assess the surgical safety, postoperative outcomes, and the impact of PPK on corneal endothelial cell density through a retrospective analysis of 22 cases. Settings and Design. A retrospective cross-sectional observational study was executed at Hermanos Ameijeiras Hospital from February 2018 to December 2021, involving 22 patients (22 eyes) who were unresponsive to other medical treatments and had a corrected distance visual acuity of ≤0.1. Methods and Materials. Patients underwent PPK, with surgical procedures and postoperative care documented. Statistical analysis was performed on qualitative and quantitative variables to evaluate the surgical outcomes and the corneal endothelial cell density changes postoperation. Results. All surgeries demonstrated a significant improvement in postoperative visual acuity () and recorded a 9.2% decrease in the corneal endothelial cell density at 12 months. Noteworthy complications included one case of intraoperatively discovered haptic dislocation and one postoperative bacterial keratitis. Conclusions. PPK could potentially mitigate perioperative complications, ensure graft clarity, and reduce corneal endothelial cell loss, presenting itself as a viable alternative to traditional PK. Although the results are encouraging, larger-scale studies are essential to validate the benefits and applicability of PPK in broader clinical settings.