Background: Corneal blindness has been significant cause of visual impairment in developing countries. The definitive surgical intervention for restoring vision or preserving globe integrity in advanced corneal disease. Institutional outcome analysis is essential to understand regional disease patterns and surgical results.
Objectives: To evaluate the demographic profile, clinical indications and postoperative outcomes of keratoplasty performed at a tertiary care centre. 
Materials and Methods: This hospital-based observational study included patients undergoing keratoplasty for 18-months. Demographic details, clinical indications, type of keratoplasty, pre and postoperative visual acuity, graft clarity, central corneal thickness, postoperative complications were recorded. Patients followed for 6 months. Statistical analysis performed using SPSS, with p ≤ 0.05 considered significant
Results: A total of 75 patients were included. As our eye bank is new, included number of patients are limited. The majority were aged 51–60 years (26.7%), with male predominance (60%) and rural/semi-urban residence (61.3%). Infective keratitis was the most common indication (37.3%), followed by corneal scarring (24%).Optical penetrating keratoplasty (37.3%) and therapeutic penetrating keratoplasty (36%) were the most frequently performed procedures. At six months 36.7% achieved best-corrected visual acuity ≥ 6/60 (p < 0.001) Clear or near-clear grafts (Grades 3–4) were observed in 67.7% of cases Graft failure occurred in 19.1%, predominantly in therapeutic and tectonic keratoplasty (p = 0.002)
Conclusion: Keratoplasty provides meaningful anatomical and functional visual improvement particularly for optical indications. Therapeutic and tectonic keratoplasty remain essential for globe preservation but associated with poorer outcomes. Early referral, improved postop compliance are crucial to improving results.