**4. Discussion**

6 Keratoplasties – Surgical Techniques and Complications

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

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

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

our studies.

diagnostic categories {P=0.563}.Table3

25 years old the main diagnoses were Corneal locum (Table 4).

 **Residence City village Corneal locuma** (54.72%)29 (68.66%)46 **Keratoconus** (32.07%)17 (8.95%)6

**The else** (13.21%)7 (22.39%)15 **Total** (100%)53 (100%)67

P=0/015 df=2 value=8/381

Table 2. Relationship between cause of PK and Residence

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 corneal diseases in the Iran -Birjand .

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

Clinical Indications for Penetrating Keratoplasty and

and the emergence of new surgical techniques.

indication for corneal transplantation (16).

2007 Jun; 26(5):561-3

*WHO* 1995;73:116-21

21(2):148-51.

*1990; 21:227* 

*India. Cornea.* 2005 Nov;24(8):989-91.

Eye Bank Association of America.

112/eeb1125.pdf (accessed 2004 Oct 11).

*Ophthalmol (Copenh).* 1994 Aug;72(4):443-6.

**5. Conclusions** 

**6. References** 

recent literature in Iran.

deep vascularization and eyelid and conjunctiva defects.

Ophthalmic Epidemiol. 2007 Mar-Apr;14(2):70-5.

Epidemiological Study in Teaching Hospitals of Birjand Medical University from 1999 to 2006 9

(27%), pseudophakic bullous keratopathy and corneal dystrophies (20). The difference in our results and them can be explained by the more frequent presence of corneal infectious and traumatic insults such as trachoma, herpes simplex and bacterial ulcers. Dobbin has reported trauma as the main cause of corneal scarring but trauma with Thorn barberry and ocular adnexal infection may be more important causes of corneal scarring in our study. Also, the decreases of bullous keratopathy disorders are due to changes in surgical practice,

The rate of corneal transplant rejection in most studies is between 9.9 and 17.2% but we had a failure rate of 12.3% because of poor prognosis factors in most scarred corneas such as

There is no significant difference in the indications and outcome of corneal transplantation between males and females as could be expected (12) but other studies may show a predominance of keratoconus and trauma in males and Fuchs' dystrophy in females as

Corneal scar and Keratoconus is the most common indication for PK in teaching hospitals of Birjand Medical University, Iran. These findings were in agreement with data reported in

[1] Godeiro KD, Coutinho AB, Pereira PR, Fernandes BF, Cassie A, Burnier MN

[2] Kanavi MR, Javadi MA, Sanagoo M*. Indications for penetrating keratoplasty in Iran. Cornea.*

[3] Thylefors B, Negrel AD, Pararajasegaram R, Dadzie KY. Global data on blindness. *Bull* 

[4] Vail A, Gore SM, Bradley BA, Easty DL, Rogers CA, Armitage WJ. *Influence of donor and histocompatibility factors on corneal graft outcome. Transplantation.* 1994;58(11):1210-6. [5] Sony P, Sharma N, Sen S, Vajpayee RB. *Indications of penetrating keratoplasty in northern* 

[6] Cosar CB, Sridhar MS, Cohen EJ, Held EL, Alvim PT, Rapuano CJ, et al. Indications for

[7] Eye Bank Association of America. 2003 Eye Banking Statistical Report. Washington, DC:

[8] Human organ and tissue transplantation. Report by the Secretariat. Executive Board,

[9] *Kervick GN, Shepherd WFI. Changing indications for penetrating keratoplasty. Ophthalmic Surg* 

[10] *Haamann P, Jensen OM, Schmidt P: Changing indications for penetrating keratoplasty, Acta* 

penetrating keratoplasty and associated procedures, 1996-2000. Cornea. 2002;

EB112/5, 112th session, Provisional agenda item 4.3. World Health Organization. May 2003. Available: http://www.who.int/gb/eb wha/pdf \_files /EB

Jr.*Histopathological diagnosis of corneal button specimens: an epidemiological study.*


Table 4. Comparison of cause of PK in age groups

keratoconus. Similar to this finding, studies in Nakorn hospital (17)showed that The leading indications for penetrating keratoplasty, in order of decreasing frequency, were bullous keratopathy (28.9%), corneal scar (22.2%), corneal dystrophy and degeneration (20.0%), corneal ulcer (17.8%), re-graft (8.9%), and trauma (2.2%)(17). In other words, pseudophakic bullous keratopathy and corneal scar were the most common indications (17). In the study in French in 2001 pseudophakic bullous keratopathy (27.7%), keratoconus (25.3%), was the most common indication (18). In Atlanta in 2001 study showed reoperative graft (29.1%), bullous keratopathy (21.5%), keratoconus (23%), corneal scar (19%), was the most common indication (19). In the study in Iran (Teaching Hospital of Medical yazd University) between 1992 and 1996, The most common indication for PK was keratoconus (31%), corneal scar (27%), pseudophakic bullous keratopathy and corneal dystrophies (20). The difference in our results and them can be explained by the more frequent presence of corneal infectious and traumatic insults such as trachoma, herpes simplex and bacterial ulcers. Dobbin has reported trauma as the main cause of corneal scarring but trauma with Thorn barberry and ocular adnexal infection may be more important causes of corneal scarring in our study.

Also, the decreases of bullous keratopathy disorders are due to changes in surgical practice, and the emergence of new surgical techniques.

The rate of corneal transplant rejection in most studies is between 9.9 and 17.2% but we had a failure rate of 12.3% because of poor prognosis factors in most scarred corneas such as deep vascularization and eyelid and conjunctiva defects.

There is no significant difference in the indications and outcome of corneal transplantation between males and females as could be expected (12) but other studies may show a predominance of keratoconus and trauma in males and Fuchs' dystrophy in females as indication for corneal transplantation (16).
