Large-Diameter Optical Penetrating Keratoplasty: Indications, Mid-term Outcomes, and Literature Review
Bibliographic record
Abstract
PURPOSE: To report the indications, outcomes, and complications associated with large-diameter penetrating keratoplasty (PK). DESIGN: Retrospective case series. METHODS: Eligible patients were adults (≥18 years) who underwent large-diameter (≥8.75 mm) PK at 2 tertiary academic centers in Toronto, Canada, between April 2005 and February 2025. Primary outcome measures included graft clarity and survival. Secondary outcomes included tectonic stability, graft rejection, best-corrected visual acuity (BCVA), postoperative complications, and repeat keratoplasty rates. Outcomes were stratified by surgical indication and graft survival over time was analyzed using Kaplan-Meier survival curves. RESULTS: A total of 47 eyes were included, with a mean follow-up of 4.5 ± 2.0 years. Indications included corneal ectasia (n = 15), failed graft (n = 15), corneal perforation (n = 11), and corneal scar following treated infectious keratitis (n = 6). The mean donor trephine size was 9.2 ± 0.6 mm and the mean recipient trephine size was 9.0 ± 0.5 mm. Graft clarity was maintained in 35 eyes (74.5%) and tectonic stability was achieved in 39 eyes (83.0%). Graft rejection occurred in 17 eyes (36.2%), and graft failure in 12 eyes (25.5%). Final BCVA varied by indication, with more favorable visual outcomes observed in eyes treated for corneal ectasia (mean 0.40 ± 0.32 logMAR, Snellen equivalent ∼20/50). CONCLUSIONS: Large-diameter PK is a viable surgical approach for complex corneal pathology, demonstrating favorable outcomes in graft clarity and tectonic stability, particularly in ectatic disorders. These results underscore the need for careful patient selection and vigilant postoperative monitoring.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".