What Is Therapeutic Keratoplasty?

When It Is Needed

Therapeutic keratoplasty is considered when infection or inflammation continues to worsen despite appropriate treatment. This can include rapidly progressive bacterial, fungal, viral, or Acanthamoeba keratitis, especially when there is deep stromal involvement. It may also be used when there is impending perforation, uncontrolled melt, or extension toward the limbus that threatens long-term eye health. The timing can be urgent to prevent endophthalmitis or loss of the globe.

Main Goals of the Procedure

The goals focus on controlling disease and protecting the eye.

• Remove infected or necrotic corneal tissue that is not responding to medication
• Reduce microbial and inflammatory load to slow stromal melt
• Restore or maintain globe integrity when thinning is severe

Visual rehabilitation may require additional procedures later if the graft becomes clear and stable.

How It Is Performed

The surgeon excises the diseased corneal tissue with margins that aim to remove active infection. A donor graft is then placed and secured, often using full-thickness penetrating keratoplasty in severe ulcers, although technique depends on depth and location. Intensive antimicrobial therapy usually continues after surgery, guided by culture results when available. Close monitoring is needed because infection can recur and inflammation can be intense.

Outcomes and Risks

Therapeutic keratoplasty has higher complication risk than elective optical transplantation because many eyes are inflamed or infected at baseline. Potential issues include recurrent infection, graft failure, rejection, secondary glaucoma, and significant postoperative astigmatism. Healing can be slower if there is ocular surface disease or persistent epithelial defect. Seek urgent care for increasing pain, redness, discharge, or sudden vision decline.