Penetrating keratoplasty (PK), also known as corneal transplantation or full-thickness corneal grafting, is a surgical procedure in which a damaged or diseased cornea is replaced with a healthy cornea from a donor. It is performed to restore vision in individuals with corneal conditions that cannot be adequately treated by other means.

Here’s an overview of the PKP procedure:

  1. Preoperative evaluation: Before undergoing PKP, the patient undergoes a thorough examination by an ophthalmologist to assess the condition of the cornea and overall eye health. Tests such as corneal topography, pachymetry, and endothelial cell count may be performed to determine the suitability for surgery.
  2. Donor cornea selection: A suitable cornea from a deceased donor is obtained through an eye bank. The donor cornea is thoroughly screened for infectious diseases and evaluated for quality and suitability for transplantation.
  3. Anesthesia: The patient is given local or general anesthesia to ensure comfort during the procedure. The specific choice of anesthesia depends on various factors, including the patient’s age, overall health, and surgeon’s preference.
  4. Corneal graft preparation: The surgeon marks the recipient cornea and carefully measures its dimensions. A circular trephine or laser is used to remove the central portion of the recipient cornea. The donor cornea is also prepared by removing a similar-sized circular portion.
  5. Graft placement: The donor cornea is then carefully sutured into place using tiny stitches. The surgeon ensures that the cornea aligns properly and sutures it to the recipient eye, ensuring a secure fit. The number and pattern of sutures may vary depending on the surgeon’s preference and the patient’s condition.
  6. Postoperative care: After the surgery, the patient is prescribed medications, including antibiotic and anti-inflammatory eye drops, to prevent infection and manage inflammation. Regular follow-up visits are scheduled to monitor the healing process and adjust medications as necessary.

Recovery and visual improvement after PKP can vary depending on individual factors, but it generally takes several months for the vision to stabilize. Visual rehabilitation, such as the use of glasses or contact lenses, may be needed after the procedure to optimize vision.

PKP is typically performed for conditions such as corneal scarring, corneal dystrophies, corneal degeneration, corneal infections, or corneal thinning disorders. However, it is important to note that PKP is a major surgical procedure and carries potential risks and complications, including graft rejection, infection, astigmatism, and prolonged healing time.

The decision to undergo PKP is made after a thorough evaluation and discussion between the patient and the ophthalmologist, weighing the potential benefits against the risks involved.

Post Operative Care

After undergoing a Penetrating Keratoplasty (PKP) procedure, it is important to follow specific post-operative care instructions to promote proper healing and reduce the risk of complications. The exact post-operative care regimen may vary depending on the surgeon’s preferences and the individual patient’s needs. Here are some common post-operative care guidelines for PKP:

  1. Medications: The surgeon will prescribe a regimen of eye drops and/or ointments to be used after the surgery. These medications may include antibiotic drops to prevent infection and anti-inflammatory drops to control inflammation. It is crucial to follow the prescribed medication schedule and dosage as instructed.
  2. Eye protection: It is essential to protect the eye from injury or trauma during the healing period. Your surgeon may recommend wearing an eye shield or protective glasses during the day and while sleeping to prevent accidental rubbing, poking, or exposure to dust or debris.
  3. Avoiding eye strain: During the initial healing phase, it is advisable to avoid activities that may strain the eyes, such as reading, watching television, or using digital screens excessively. Resting the eyes can help promote healing and reduce discomfort.
  4. Physical activity restrictions: Strenuous physical activities, such as heavy lifting, bending, or intense exercise, should be avoided for several weeks after surgery. These activities can increase intraocular pressure and interfere with the healing process. Your surgeon will provide specific instructions regarding activity restrictions and when it is safe to resume normal activities.
  5. Follow-up appointments: Regular follow-up visits are crucial to monitor the healing progress and assess the health of the transplanted cornea. Your surgeon will schedule these visits according to your individual needs. During these appointments, your eye will be examined, and any necessary adjustments to medications or treatment plan will be made.
  6. Proper hygiene: Maintaining good hygiene is important to prevent infection. Your surgeon will provide instructions on how to keep the eye clean and provide guidelines for washing hands before administering eye drops or touching the eye area.
  7. Protective eyewear: After the initial healing period, your surgeon may recommend wearing sunglasses or protective eyewear outdoors to shield the eye from excessive sunlight and to prevent potential trauma to the eye.

It is crucial to closely follow your surgeon’s instructions and attend all scheduled follow-up appointments. If you experience any unusual symptoms, such as severe pain, sudden vision changes, increased redness, or discharge from the eye, it is important to contact your surgeon promptly.

Remember that the post-operative care instructions may vary depending on individual factors and the surgeon’s preferences, so it is important to consult your surgeon for personalized advice and guidance.

This article was originally written on 5/29/2023 by Angelique Pillar, MD.