**3. Result**

4 Keratoplasties – Surgical Techniques and Complications

*Optical*: To improve visual acuity by replacing the opaque or distorted host tissue by clear healthy donor tissue. The most common indication in this category is pseudophakic bullous keratopathy, followed by keratoconus, corneal degeneration, keratoglobus and dystrophy,

*Tectonic/reconstructive*: To preserve corneal anatomy and integrity in patients with stromal thinning and descemetoceles, or to reconstruct the anatomy of the eye, e.g. after corneal

*Therapeutic*: To remove inflamed corneal tissue unresponsive to treatment by antibiotics or

*Cosmetic*: To improve the appearance of patients with corneal scars that have given a whitish

To update these trends and also to provide information for the prevention of corneal blindness we report the indication causes for penetrating keratoplasty (PK) in Teaching

A retrospective analysis of the records of 120 patients, who underwent PK at the Emam-reza and Vali-asr teaching hospitals of Birjand University during 7- year period from 1999 to

All surgeries were performed by one expert surgeon using the same procedure and there were no intra-operative complications. Preoperative examinations consisted of visual acuity, refractive error and slit-lamp examination. Patient's pre-operative information included age, sex, systemic disease, lid abnormalities, pre-existing ocular surface disease and corneal vascularization, surgical indications and preoperative medications. The data of the last examination including uncorrected visual acuity (UCVA), refractive error, intra-ocular Pressure (IOP), graft clarity, any episode of endothelial graft rejection during the follow-up,

graft failure and recurrence of MCD in the transplanted cornea were compiled Patients were followed up for a minimum of 2 years .This data were analyzed regarding sex, age, indication, job and location of the patient. Statistical significance was determined using X2 analysis and descriptive statistic measures including percentiles, mean and standard deviation were calculated. Personal information of patients was not disclosed and the data

The donor lenticule was secured to the recipient corneal rim with 10-0 monofilament nylon sutures. The suturing techniques consisted of interrupted (16 separate sutures), single running (with 16 bites), and combined (8 separate sutures and a 16-bite running suture). At the end of the operation, subconjunctival gentamicin 20 mg and betamethasone 4 mg were injected. Postoperatively, the patients were medicated with topical betamethasone 0.1% and choloramphenicol eye drops four times a day. Antibiotic eye drop was discontinued after 7 to

Selective suture removal was performed for any suture-related problems and for control of astigmatism, based on topography, from four month onward. Suture removal was completed between 12 and 18 months after the date of the surgery. Patients were examined on 1st, 2nd, 3rd and 7th days and then every week up to one month, every 2 weeks up to 2 months, monthly up to 4 months, and every 2 months thereafter. Finally, Two months after

also, suturing technique and intraoperative complications were recorded.

10 days and betamethasone eye drop was gradually tapered over 4 months.

complete suture removal, patients were reevaluated.

as well as scarring due to keratitis and trauma.

Hospitals of Medical Birjand University from 1999 to 2006.

perforation.

anti-virals.

or opaque hue to the cornea.

**2. Methodology** 

2006, was performed.

sheets were anonymous.

A total of 120 patients underwent PK operations during the 7-year study period. From 120 patients; 86(71/66%) were male and 34(28/33%) were female. The mean patient's age was 53 years with a standard deviation (SD) of 20.9 and a median of 59 years. The mean age of males was 51/3±21.5 and for women was 57/2±19/1. (P=0.26)

And also, the average age of rural patients was 61± 17.4 and urban patients were 42.7 ± 20.7, in statistically, there is a significantly difference between the average age of rural patients group in compared with average age of urban patients group. (p=0.001).

The main indications cause keratoplasty were corneal locuma 75(62.5%), keratoconus 23(19.16%) and others (Bolus keratopaty + corneal dystrophy) 22(18.34%). (p=0.001) (Table1).


Table 1. Evaluation of indication cause of keratoplasty in Job groups

Clinical Indications for Penetrating Keratoplasty and

Epidemiological Study in Teaching Hospitals of Birjand Medical University from 1999 to 2006 7

**Sex Male Female Corneal locuma** (61.63%)53 (64.70%)22 **Keratoconus** (23.25%)20 (14.71%)5 **The else** (15.12%)13 (20.59%)7 **Total** (100%)86 (100%)34

P=0/563 df=2 Value:1/151

Table 3. Relationship between cause of PK and sex groups

Penetrating keratoplasty can visually rehabilitate many of those who suffer from blindness or visual impairment due to corneal diseases. The prognosis of the outcome, however, is dependent on the pathology responsible for causing corneal blindness or visual impairment. [13][14][15] The purpose of our study was to document the indications for PK in Teaching Hospitals of Medical Birjand University which is a major referral centre for the treatment of

In this study we found that the leading indications for PK were corneal scar (43%), keratoconus (20%), bullous keratopathy (16%), and corneal dystrophy and degeneration (11%). In other words, the most common indication for PK was corneal scarring and

**4. Discussion** 

corneal diseases in the Iran -Birjand .

The major job for keratoplasty group was agriculture 29(76%) and housekeeping(not busy) 25(68%). because of frequent presence of corneal infectious and traumatic insults such as trachoma, herpes simplex and bacterial ulcers and trauma with Thorn barberry and ocular adnexal infection, it may be the most important cause of corneal scarring in our studies.

In corporation for indication cause of keratoplasty, there was a significantly difference between the rural patients group and urban patients groups, as shown in (table 2) (P=0.0015) but no significant sex difference was found for the cause of keratoplasty in diagnostic categories {P=0.563}.Table3

similar to this finding, studies for indication cause of keratoplasty according to age showed a significantly difference between the age and cause of PK (P=0.001) In other words, in The ages under 25 years old the main diagnoses were keratoconus (75%)15,and in The ages over 25 years old the main diagnoses were Corneal locum (Table 4).


Table 2. Relationship between cause of PK and Residence


Table 3. Relationship between cause of PK and sex groups
