Evolving surgical techniques of and indications for corneal transplantation in Ontario: 2000 - 2012

Objective: To evaluate trends in indications for and preferred surgical techniques of corneal transplantation in Ontario over a 12-year period.

Design: Retrospective review of recipient information forms collected by Eye Bank of Canada (Ontario Division).

Participants: Patients who received corneal transplantation in Ontario between 2000 and 2012, totaling 11,725 corneal transplants performed.

Methods: Database containing information collected from recipient information forms maintained by the Eye Bank of Canada (Ontario Division) was reviewed. Corneal transplants performed between July 1, 2000, and June 30, 2012, in Ontario were analyzed. Surgeons complete recipient information forms at the time of corneal transplant surgery. Of the 11,725 available recipient information forms, 10,906 (93%) were sufficiently complete to meet the inclusion criteria and were included in the study.

Results: Since 2009, Fuchs endothelial dystrophy overtook pseudophakic corneal edema as the leading indication for corneal transplantation. Since the shift toward lamellar keratoplasty in 2006, there has been a significant decrease in number of corneal transplants performed with penetrating keratoplasty (PKP; p = 0.0016) and a significant increase in Descemet stripping automated endothelial keratoplasty (DSAEK; p = 0.0069) and deep anterior lamellar keratoplasty (p = 0.0108). The gap between number of PKPs and DSAEKs performed each year is progressively narrowing. From July 1, 2011, to June 30, 2012, 514 PKPs were performed compared with 420 DSAEKs. From 2011 to 2012, 83% of corneal transplants indicated by Fuchs endothelial dystrophy were performed with DSAEK, whereas only 13% were performed with PKP.

Conclusions: Six years since initial implementation, partial thickness transplantation continues to increase in popularity. Corneal tissue supply and demand will need to reflect these changes in the field of corneal transplantation.