A corneal ulcer refractory to medical management often proceeds to therapeutic penetrating keratoplasty in the late stages.
Therapeutic penetrating keratoplasty (TPK) in such cases usually is performed to remove the infective load, and these eyes will require optical keratoplasty subsequently. Even though the infective source is removed from the eye after TPK, the visual acuity remains subnormal in such eyes due to poor quality of the cornea and nonavailability of high-grade donor cornea during the TPK period. Nevertheless, doing an endothelial keratoplasty such as pre-Descemet’s