Corneal transplant in topical anesthetic abuse keratopathy: To do or not to do?

This study reports the outcomes of corneal transplantation in two cases of topical anesthetic abuse keratopathy. A chart review was performed for two patients who underwent penetrating topical anesthetic abuse keratoplasty (PK) due to keratopathy-related sequelae. The first case presented with unilateral full-thickness corneal perforation and a best-corrected visual acuity (BCVA) of hand motion. A tectonic PK was performed to restore globe integrity; however, the patient continued using topical anesthetic drops, and eight months postoperatively developed graft failure, with a final BCVA of hand motion. The second case presented with a unilateral corneal scar due to topical anesthetic abuse, with an initial BCVA of hand motion. PK was performed for visual rehabilitation, and the early postoperative course was uneventful with BCVA of 20/50. The patient missed scheduled follow-up visits and returned at the third postoperative month with loose sutures and signs of graft rejection. After suture removal and topical therapy, the clinical findings improved, and the final BCVA was 20/100. Psychiatric evaluation of both patients revealed severe anxiety and aggression. These cases highlight that uncontrolled use of topical anesthetic eye drops leads to irreversible ocular surface damage, and corneal transplantation in such patients has limited success due to poor compliance, often resulting in graft rejection and graft failure.