Therapeutic Penetrating Keratoplasty for Infectious Corneal Ulcers: Outcomes and Timing

Abstract Purpose Therapeutic penetrating keratoplasty (PKP) is often required in severe infectious keratitis unresponsive to medical therapy. This study evaluates visual and surgical outcomes of therapeutic PKP and explores whether surgical timing influences recurrence, transplant failure, or visual outcomes. Methods A retrospective review of 56 patients who underwent PKP for infectious keratitis at a US tertiary academic center between 2014 and 2020. Clinical data including time from ulcer onset to surgery, ulcer size, causative organism, and postoperative outcomes (recurrent infection, graft failure, final VA) were analyzed. Results Of 46 patients with > 30 days of follow-up, 37.0% had persistent infection, 34.8% experienced transplant failure, and 32.6% required repeat PKP. Longer time to PKP was significantly associated with infection recurrence (median 60.0 vs 17.5 days, p = 0.02). Timing of surgery did not influence transplant failure or final VA. Conclusion Therapeutic PKP is associated with high complication rates in infectious keratitis. Earlier surgical intervention may reduce the risk of recurrent infection, though it does not appear to affect final vision or graft failure. Early surgical consideration may be warranted when infections fail to respond to medical therapy.