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First Author: J.Tan CANADA
Co Author(s): S. Holland G. Moloney M. McCarthy P. Dubord S. Yeung
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To report the evolving indications of keratoplasty, and the shift in the type of keratoplasty performed in British Columbia, Canada over a 10-year period from 2002 to 2011.
Eye Bank of British Columbia, Canada
Retrospective database review of all records of corneal transplantation tissues at the Eye Bank of British Columbia, Canada, from January 2002 to December 2011. The patient demographics, indications and type of transplant performed, waiting time, priority score, and immediate post-keratoplasty complications were analyzed.
4843 corneal transplantations were performed in 3742 patients (1968 male and 1774 female) from January 2002 to December 2011. The number of keratoplasties per year ranged from 420 in 2008 to 578 in 2011. Penetrating keratoplasties (PK) accounted for 86.54% (4191 transplants) of all keratoplasties performed. Since the introduction of Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in 2007, there was a significant decline in the number of PKs in 2008, but remained stable from 2008 to 2011. There was a significant increase in DSAEK from 2007 to 2011 (P<0.0001), and for Deep Anterior Lamellar Keratoplasty (DALK) over the 10 year period (P=0.0087). The top 4 indications over the 10-year period were Fuchs endothelial dystrophy (18.94%), aphakic/pesudophakic bullous keratopathy (17.43%), regrafts (17.06%), and keratoconus (15.53%). There was a decreasing trend for PK and increasing trend for DSAEK performed for Fuchs endothelial dystrophy, aphakic/pesudophakic bullous keratopathy and regrafts. Among the top 4 indications, regrafts had the worst preoperative mean best-spectacle visual acuity (1.79ḟ0.72) and the shortest waiting time (5.4ḟ7.89 months). There were 17 primary graft failures (0.37%) and 5 cases of endophthalmitis (0.11%).
There was a shift from penetrating keratoplasty to lamellar keratoplasty in transplants performed for endothelial failure since the introduction of DSAEK. With aging population and improved technology in cataract surgeries, there were increasing corneal transplantations performed for Fuchs endothelial dystrophy and inversely so for aphakic/pesudophakic bullous keratopathy.