To evaluate the changes in corneal higher-order aberrations (HOAs) after penetrating keratoplasty (PKP) and to investigate the factors affecting the changes in corneal HOAs.

Forty-eight eyes of 48 patients with three different underlying diseases who underwent PKP were retrospectively reviewed. The changes in corneal higher-order aberrations (total root mean square (RMS), coma, trefoil, and spherical aberration) were evaluated with Pentacam (Oculus Inc., Dutenhofen, Germany) at 1, 3, 6, 12, and 18 months postoperatively. Sex, age, underlying disease, suturing method, trephine size of donor, and suture state were analyzed as factors affecting the HOAs changes.

Total RMS values in the PKP eyes were 1.67 ± 0.49 µm at 1 month, 1.63 ± 0.49 µm at 3 months, 1.64 ± 0.51 µm at 6 months, 1.61 ± 0.50 µm at 12 months, and 1.79 ± 0.40 µm at 18 months after surgery ( p < 0.01). The values were higher compared with those in the control eyes. Sex, donor trephine size and suture method did not correlate with the HOAs changes. The HOAs in the keratoconus group were higher than those in the corneal opacity group or bullous keratopathy group. At 18 months, HOAs in the suture removed group were higher than those in the suture-remaining group.

Corneal HOAs after PKP were persistently higher than those in the control eyes. The HOAs were higher in patients with keratoconus and in the suture-removed group.