OP4.7 | Keratoplasty: Types and Indications — Summary & Reflection

KEY TAKEAWAYS

Keratoplasty is classified by depth into lamellar and penetrating. Lamellar: DALK (deep anterior — removes stroma down to Descemet's, preserves host endothelium; no endothelial rejection; indication: keratoconus, anterior stromal scars with healthy endothelium); DSEK/DMEK (endothelial only — replaces Descemet's + endothelium; faster recovery, lower rejection; indication: Fuchs' dystrophy, pseudophakic bullous keratopathy). PK (penetrating — all five layers; indicated when Descemet's/endothelium involved or tectonic/therapeutic need; lifelong rejection prophylaxis with topical steroids required).

Indications by category: optical (vision restoration — most common), tectonic (structural integrity), therapeutic (remove uncontrolled infection), cosmetic.

Graft rejection: four types — epithelial (Eisner's line), subepithelial (Krachmer's spots), stromal (haze), endothelial (Khodadoust line — most serious, advancing line of endothelial KPs). Warning symptoms — RSVP: Redness, Sensitivity, Vision decrease, Pain. Emergency treatment: topical prednisolone 1% every hour ± systemic steroids.

Complications: post-keratoplasty astigmatism (commonest visual complication of PK), late endothelial failure, secondary glaucoma, recurrence of original disease.

REFLECT

Keratoplasty depends entirely on voluntary eye donation — without donor corneas, there are no grafts. India has approximately 750 eye banks but procures far fewer corneas than needed annually. The RSVP symptoms you teach your patient today to recognise rejection are only meaningful if they have a graft to protect. Reflect: as a future doctor who will certify deaths and work in hospitals, how would you approach a conversation with the family of a recently deceased patient about eye donation? What are the common myths and fears that families hold about eye donation in India, and how would you address them? This connects directly to SDL 8.