To report the long term clinical results of penetrating keratoplasty as a treatment for corneal macular dystrophy.

Retrospective review of the medical record of 46 eyes (31 indivisuals) who underwent primary PK for corneal macular dystrophy at the Seoul St. Mary's Hospital between November, 1986 and December, 2011. Data extracted preoperative and postoperative best-corrected visual acuity (BCVA), postoperative complications (including graft rejection episodes, and recurrent dystrophy), change of endothelial cell density at 1, 6, 12, 24, 36 months and yearly thereafter.

After a mean follow-up period of 91.59 ± 3.2 months, the mean BCVA was significantly improved after penetrating keratoplasty. Endothelial cell loss rate was marked during the 1st year after penetrating keratoplasty. Graft survival was 40 graft (89.7%) at 8yrs. There was a statistically significant increased likelihood of graft failure if the patient was older than 40 years at the time of surgery ( p = 0.03). Glaucoma as postoperative complication was 17.4%. Clinically significant recurrence was 2%.

Penetrating keratoplasty is associated with a good visual outcome and prognosis for graft survival of long-term efficacy with a low complication rate in eyes with macular corneal dystrophy.