Outcome of keratoplasty in India over the last decade: A systematic review and meta-analysis

Corneal blindness remains a major cause of visual impairment in India, and keratoplasty is the definitive treatment for many corneal pathologies, though outcomes vary by indication and surgical technique. This systematic review and meta-analysis synthesized keratoplasty outcomes reported from India between 2014 and 2024, focusing on one-year graft survival, anatomical success following therapeutic penetrating keratoplasty (TPK), and functional visual outcomes. A comprehensive search of PubMed, Embase, Scopus, Web of Science, and Google Scholar identified studies reporting keratoplasty outcomes with at least one-year follow-up. Single-arm proportions were pooled using DerSimonian–Laird random-effects meta-analysis after logit transformation, and heterogeneity was assessed using Cochran’s Q and I² statistics. Thirteen studies met the inclusion criteria. The pooled one-year graft survival rate from five cohorts was 84.7% (95% CI, 69.4–93.1). Anatomical success following TPK, pooled from two studies, was 89.3% (95% CI, 86.5–91.6). Functional visual outcome, defined as best-corrected visual acuity ≥6/60, was achieved in 51.2% of eyes (95% CI, 6.0–94.5) based on three studies, with substantial heterogeneity. Sensitivity analyses excluding studies with imputed data yielded similar point estimates, while subgroup analyses suggested better functional outcomes in elective keratoplasty compared with therapeutic cohorts. Overall, keratoplasty outcomes in India demonstrate favorable anatomical success and acceptable short-term graft survival, but visual rehabilitation remains variable, highlighting the need for standardized outcome reporting and prospective multicenter registries.