LAUSR

To the Editor: We commend Ayalew et al1 for an excellent study describing the indications, visual acuity outcomes, and graft survival after penetrating keratoplasty (PKP) in Addis Ababa, Ethiopia. However, a few untouched and warranted issues need further discussion. First, were systemic factors such as diabetes and smoking2 taken into account while evaluating results? Their presence could have decreased the endothelial counts, leading to lesser success rates. Second, Hu et al3 found that the average endothelial cellular density decreased from 2525 6 267/mm2 before transportation to 1934 6 250/mm2 after transportation (P , 0.001), with an average endothelial cellular loss of 590 6 247/mm2. What was the average endothelial cell density before and after transportation in this study for the imported corneas? How many donors were phakic/aphakic/pseudophakic? This could have affected the endothelial counts and subsequently the success rates of PKP. Last, there is a discrepancy in the number of patients who underwent PKP. In the Abstract, it is mentioned “A total of 321 patients underwent PKP during the study period,” whereas in the Results section, it is written as, “A total of 332 patients underwent PKP between September of 2000 and September of 2013.” Moreover, there is a mismatch in the “Others” category between what is mentioned in Table 1 (n = 7) and in the Results section (n = 8).