To compare long-term outcomes of penetrating keratoplasty in treating macular corneal dystrophy, transforming growth factor beta induced (TGFBI) dystrophy, and Fuchs' dystrophy.

The present retrospective study describes the postoperative results of 123 eyes in 70 patients; 53 eyes with macular corneal dystrophy, 20 eyes with TGFBI dystrophy, and 50 eyes with Fuchs' dystrophy. All patients received penetrating keratoplasty. The outcome measures included recurrence rate, graft rejection, graft survival rate and corneal endothelial density and other complications.

As compared with the other groups, TGFBI dystrophy had the highest recurrence rate ( p -value < 0.0001). Fuchs' dystrophy had the lowest graft survival rate ( p -value = 0.03). Corneal endothelial cell density was lowest in Fuchs' dystrophy 10 years postoperatively ( p -value = 0.0006), but there was no significant difference in corneal endothelial cell density between the 3 groups 1 and 5 years postoperatively. There was no significant difference between the 3 groups in other complications such as graft rejection, secondary glaucoma and persistent epithelial defect ( p -value = 0.809, p -value = 0.584, p -value = 0.972, respectively).

Penetrating keratoplasty showed different long-term outcomes in treating 3 types of corneal dystrophies. The difficulty may depend on the pathogenesis of corneal dystrophies.