Assessment Of Risk Factors and Outcomes of Posterior Segment Complications Following Therapeutic Penetrating Keratoplasty- A Prospective Cohort Study

Therapeutic penetrating keratoplasty (TPK) is a surgical intervention performed to eliminate infection when medical treatment fails, primarily in cases of fungal keratitis. Corneal transplantation can be either full-thickness (penetrating keratoplasty) or partial-thickness (lamellar keratoplasty), with penetrating keratoplasty serving various purposes, including tectonic, therapeutic, cosmetic, and optical restoration. Corneal blindness affects approximately 1.5 to 2 million individuals annually, with corneal opacity accounting for 7.4% of blindness among individuals aged greater than  or equal to 50 years and 37.5 percent in those aged 0-49 years in India. Late diagnosis and delayed treatment frequently necessitate emergency TPK, which carries risks of intraoperative complications, including intraocular infection spread and expulsive choroidal hemorrhage, along with postoperative complications such as glaucoma, graft failure, retinal detachment, recurrent infection, and increased intraocular pressure. This study aims to analyze the incidence of posterior segment complications following TPK and identify associated risk factors. Patients aged 18 years and above undergoing TPK at Aravind Eye Hospital, Pondicherry, will be enrolled after providing written informed consent, while those with pre-existing posterior segment conditions will be excluded. Preoperative data collection will encompass demographic details, disease duration, keratitis type, prior keratoplasty history, visual acuity, intraocular pressure, and other infection-related parameters. Before surgery, patients will receive an intravenous infusion of 20% Mannitol (100 ml), followed by local anesthesia using facial and peribulbar blocks. The surgical procedure will be performed under continuous monitoring, with documentation of anesthesia details, intraoperative sedation, complications, and surgeon expertise. Postoperative assessments will take place on the 1st, 10th, 30th, and 90th days, covering parameters such as visual acuity, intraocular pressure, graft clarity, wound integrity, suture status, infection persistence, and posterior chamber complications. Additionally, information on resurgeries will be collected, noting the type and reasons. The operating surgeon will document details in the study proforma immediately after surgery. Study participants will remain anonymous, and all data will be used solely for academic purposes. This prospective cohort study aims to improve understanding of posterior segment complications following TPK, providing valuable insights to enhance patient outcomes and optimize treatment strategies for better postoperative recovery and complication prevention.