Corneal Transplantation in the Republic of Ireland

In line with international trends, there has been a decline in full thickness keratoplasty and a corresponding shift towards lamellar techniques in corneal transplantation practices in the Republic of Ireland.

That is the key finding of the first study to report 14 years of data from the National Corneal Transplant Registry in the Republic of Ireland.

Emmanuel Neves MD and colleagues conducted a retrospective review of keratoplasties performed in Ireland between 2012 and 2025 and charted the changes in corneal graft surgical techniques since the inception of the registry.

Key findings

A total of 2,376 keratoplasties were performed during the study period. Of these, 944 (39.7%) were penetrating keratoplasties (PK), 781 were Descemet stripping automated endothelial keratoplasties (DSAEK), 448 were Descemet membrane endothelial keratoplasties (DMEK), 137 were deep anterior lamellar keratoplasties (DALK), 49 were Boston Type 1 Keratoprostheses, and 17 were superficial anterior lamellar keratoplasties (SALK).

The leading indication for corneal surgery was Fuchs’ endothelial dystrophy (FED) at almost 25% of cases, followed by keratoconus (16.5%), and pseudophakic corneal oedema/bullous keratopathy (PBK) at just under 15% of cases.

Keratoconus was the top reason for both PK (33.3%) and DALK (55.5%), while FED and PBK accounted for 66.3% and 84.5% of DSAEK and DMEK procedures, respectively.

Over the study period, there was a significant decrease in the annual number of PK procedures and a significant increase in both DALK and DMEK procedures. The annual number of DSAEK procedures remained stable.

Comparisons to other countries

“The study allowed us to really compare what is going on in Ireland to registries in other countries, and to see if we are following the same trends,” Dr Neves told EuroTimes.

Compared to other countries, corneal grafts in Ireland are also now primarily endothelial grafts rather than full thickness grafts, he noted. “So, I think we are doing things the right way. It mirrors what is happening in Australia, the US, and the UK, and we have the data now in Ireland to show that.”

The study also shows the amount of corneal transplants being carried out in Ireland is lower than in other countries. “We are doing about 200 grafts a year, which, when adjusted for the size of the population, is still not as much [as other countries] and what we could do,” Dr Neves said.

The reasons for this will be explored further but likely reflect, in part, the need to import corneas from the US for corneal surgery in Ireland, as well as more limited surgical experience with the different techniques, Dr Neves said.

The Irish Eye Bank ceased accepting ocular donations in January 2004 due to concerns surrounding variant Creutzfeldt-Jakob Disease (vCJD). As corneas are thought to carry a higher theoretical risk of transmission of vCJD than blood, the eye bank decided to import all ocular tissue from Rocky Mountain Lions Eye Bank in Denver, Colorado, US—a vCJD-free zone. However, there is hope the Irish Eye Bank will accept local corneal donations again in the coming months.

Dr Neves reported the study data at the Irish College of Ophthalmologists 2026 annual conference in Galway.

Emmanuel Neves MD, MSc, PgDip, FEBO is an ophthalmologist completing a cornea and uveitis fellowship at the Royal Victoria Eye and Ear Hospital Dublin, Ireland. e.rebeloneves@gmail.com