Penetrating Keratoplasty in a Resource-Constrained Country: Surgical Outcomes and Challenges in the Absence of a Domestic Eye Bank

Background: Corneal blindness is a significant public health issue worldwide, particularly in resource-constrained countries with limited access to specialized ophthalmic care. Keratoplasty is one of the essential treatment approaches for rehabilitating vision in patients with corneal pathologies. Aims: The primary aim of the study was to assess the challenges faced during penetrating keratoplasty (PK) and the outcomes of surgeries in a resource-constrained country in the absence of a domestic eye bank. The secondary aim was to assess the outcomes of PK. Methods: This cross-sectional descriptive study included patients undergoing PK for various corneal pathologies at the Department of Ophthalmology, Medical Teaching Institute, Lady Reading Hospital (MTI-LRH), Peshawar, Pakistan, between January and March 2025. Results: PK was performed in 42 patients (27 (64.3%) male and 15 (35.7%) female), with a mean age of 33.9 ± 20.9 years. The right eye was involved in 16 (38.1%) patients, while bilateral cases were 13 (31.0%). The leading cause for PK was keratoconus with very low best corrected visual acuity (BCVA) (n = 15, 35.7%), followed by non-traumatic corneal opacity. The waiting period for surgery was >20 months in 31 (73.8%) patients. After PK, the patients who achieved BCVA >6/60 increased from two (4.8%) at one-day follow-up to 29 (69.1%) at six-month follow-up. The major challenge in PK was a lack of surgical tools in 33 (78.6%) patients and a delay in donor tissue availability in 30 (71.4%) patients. Conclusion: Visual acuity was significantly improved after PK, particularly at long follow-up periods. The major challenge in PK was the lack of surgical tools and the delay in donor tissue availability.