• Muhammad Sufyan Ansari Fatima Memorial Hospital, Shadman, Lahore
  • Nabila Zulfiqar Fatima Memorial college of Medicine and Dentistry shadman, Lahore
  • Khurram Nafees Fatima Memorial Hospital, Shadman, Lahore
  • Manzra Shaheen Fatima Memorial Hospital, Shadman, Lahore


Background: Keratoconus (KC) is a bilateral, asymmetric, corneal disorder that is characterized by progressive thinning, steepening, and potential scarring. In the early stages of keratoconus treatment can be modulated with contact lenses but once it reaches to scarring, penetrating keratoplasty (PK) is the standard procedure of care. As there is not enough published data on penetrating keratoplasty in Pakistan and also early visual outcomes post keratoconus keratoplasty have not been established so this study would be beneficial for further research and opting keratoplasty as a procedure for management of advance keratoconus. To determine the frequency of improvement in the visual acuity six months after penetrating keratoplasty in patients of Keratoconus. Methods: Sixty-five eyes of 65 patients fulfilling the inclusion criteria were taken from the Outdoor Clinic of Layton Rahmatulla Benevolent Trust Free Eye and Cancer Hospital. Informed consent was taken and socio-demographic data (name, age, gender, address and contact number) was also recorded. Examination included Visual Acuity with Snellen’s Chart with assessment of light projection in patients with Visual Acuity hand movements or light perception. Slit lamp examination with Haag Streit BQ 900 Slit lamp for assessing the condition of cornea was done. Indirect ophthalmoscopy was performed using 90D lens for fundus examination. B-scan (ocular ultrasonography) with Alcon B-scan was done where fundus examination was not possible. Standard surgical procedure of Penetrating Keratoplasty was carried out on all patients. Visual Acuity was recorded on Day 7, 90 and 180 after the surgery Conclusion: Penetrating Keratoplasty is a safe and reliable procedure for improvement in visual acuity of patients with keratoconus and should be conducted on mass level to avoid blindness caused by keratoconus

Author Biographies

Muhammad Sufyan Ansari, Fatima Memorial Hospital, Shadman, Lahore

Assitant Professor, Ophthalmology Department

Nabila Zulfiqar, Fatima Memorial college of Medicine and Dentistry shadman, Lahore

Demonstrator, Optometry & Orthoptics

Khurram Nafees, Fatima Memorial Hospital, Shadman, Lahore

Assitant Professor, Ophthalmology Department

Manzra Shaheen, Fatima Memorial Hospital, Shadman, Lahore

Course coordinator, Optometry & Orthoptics


Crawford AZ, Patel DV, McGhee CN. A brief history of corneal transplantation: From ancient to modern. Oman J Ophthalmol 2013;6(Suppl 1):S12–7.

Reddy JC, Hammersmith KM, Nagra PK, Rapuano CJ. The role of penetrating keratoplasty in the era of selective lamellar keratoplasty. Int Ophthalmol Clin 2013;53(2):91–101.

WHO. Visual impairment and blindness: A report by World Health Organization. [Internet]. [cited 2020 Dec]. Available from:

Channa R, Mir F, Shah MN, Ali A, Ahmad K. Central corneal thickness of Pakistani adults. J Pak Me Assoc 2009;59(4):225–8.

Khan RU, Khan MT, Saeed M. Visual Outcome after Penetrating Keratoplasty. J Sheikh Zayed Med Coll 2010;1(3):94–5.

Sagnières H, Doat M, Girard A, Legeais JM, Renard G, Bourges JL. Visual outcome in keratoconus patients 1 and 2 years after penetrating keratoplasty. Fr J Ophthalmol 2007;30(5):465–73.

Buxton JN. Contact lenses in keratoconus. Eye Contact Lens 1978;4(3):74–85.

Rabinowitz YS, Garbus JJ, Garbus C, McDonnell PJ. Contact lens selection for keratoconus using a computer-assisted videophotokeratoscope. CLAO J 1991;17(2):88–93.

Rosenthal P, Cotter JM. Clinical performance of a spline-based apical vaulting keratoconus corneal contact lens design. CLAO J 1995;21(1):42–6.

Bahar I, Kaiserman I, McAllum P, Slomovic A, Rootman D. Comparison of Posterior Lamellar Keratoplasty Techniques to Penetrating Keratoplasty. Ophthalmology 2008;115(9):1525–33.

Lim L, Pesudovs K, Coster DJ. Penetrating Keratoplasty for Keratoconus: Visual Outcome and Success. Ophthalmology 2000;107(6):1125–31.

Kirkness CM, Ficker LA, Steele ADM, Rice NSC. The success of penetrating keratoplasty for keratoconus. Eye (Lond) 1990;4:673–88.

Lass JH, Lembach RG, Park SB, Hom DL, Fritz ME, Svilar GM, et al. Clinical management of keratoconus. A multicenter analysis. Ophthalmology 1990;97(4):433–45.

Sharif KW, Casey TA. Penetrating keratoplasty for keratoconus: complications and long-term success. Br J Ophthalmol 1991;75(3):142–6.

Tuft SJ, Moodaley LC, Gregory WM, Davison CR, Buckley RJ. Prognostic Factors for the progression of keratoconus. Ophthalmology 1994;101(3):439–47.

Pouliquen Y, Forman MR, Giraud JP. Rate of progression of keratoconus. Study of the relationship between age of discovery and the age at which it is made. J Fr Ophtalmol 1981; 4:219-21.

Al-Yousuf N, Mavrikakis I, Mavrikakis E, Daya SM. Penetrating keratoplasty: indications over a 10 year period. Br J Ophthalmol 2004; 88:998-1001.

Versaci F, Vestri G. Instrumentation for Diagnosis of Keratoconus. In: Keratoconus. Springer, 2017; p.53–63.

Olson RJ, Pingree M, Ridges R, Lundergan ML, Alldredge C Jr, Clinch TE. Penetrating keratoplasty for keratoconus: a long-term review of results and complications. J Cataract Refract Surg 2000;26(7):987–91.

Epstein RJ, Seedor JA, Dreizen NG, Stulting RD, Waring GO 3rd, Wilson LA, et al. Penetrating keratoplasty for herpes simplex keratitis and keratoconus. Allograft rejection and survival. Ophthalmology 1987;94(8):935–44.

Keates RH, Falkenstein S. Keratoplasty in keratoconus. Am J Ophthalmol 1972;74(3):442–4.

Paglen PG, Fine M, Abbott RL, Webster RG Jr. The prognosis for keratoplasty in keratoconus. Ophthalmology 1982;89(6):651–4.

Troutman RC, Lawless MA. Penetrating keratoplasty for keratoconus. Cornea 1987;6(4):298–305.