Comparison of Transplantation Outcomes of Human Cornea vs. Acellular Porcine Corneal Stroma in Noninfectious Peripheral Ulcerative Keratitis: A Single-Center Retrospective Cohort Study

Abstract

Purpose: To compare the effectiveness and prognosis of lamellar keratoplasty (LK) using human cornea and acellular porcine corneal stroma (APCS) for noninfectious peripheral ulcerative keratitis (PUK). Methods: Fifty-eight patients with noninfectious PUK who underwent LK from 2013 to 2023 were included in this retrospective study. Patients were divided into human cornea (n = 27) and APCS (n = 31) groups according to corneal graft material. The primary outcome was best-corrected visual acuity (BCVA) at 1, 3, 6, and 12 months postoperatively. Kaplan–Meier analysis was used to evaluate graft survival rates within 12 months. Results: BCVA improved in both groups. The human cornea group had better BCVA at 3 months (p = 0.045) and 6 months (p = 0.010) postoperatively, but no significant difference was observed at 1 or 12 months (p > 0.05). Corneal epithelial healing time was similar overall, but prolonged in the APCS group among patients with autoimmune diseases (p = 0.012). The number of transparent corneal grafts was higher in the human cornea group at 1, 3, and 6 months (p < 0.05), but comparable at 12 months (p > 0.05). Complications occurred in 13 APCS patients and 10 human cornea patients (p > 0.05). Graft survival rates were 80.6% for APCS and 88.8% for human cornea at 12 months (p > 0.05). Conclusion: APCS is a feasible alternative for noninfectious PUK, with promising visual recovery and long-term outcomes. However, its midterm effectiveness may be slightly inferior, especially in patients with autoimmune diseases, suggesting a need for tailored approaches.