Indications for corneal transplantation at a tertiary referral center in tehran

Abstract

Purpose: To report the indications and techniques of corneal transplantation at a tertiary referral center in Tehran over a 3-year period.

Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran from March 2004 to March 2007 were reviewed to determine the indications and types of corneal transplantation.

Results: During this period, 776 eyes of 756 patients (including 504 male subjects) with mean age of 41.3±21.3 years underwent corneal transplantation. The most common indication was keratoconus (n=317, 40.8%) followed by bullous keratopathy (n=90, 11.6%), non-herpetic corneal scars (n=62, 8.0%), infectious corneal ulcers (n=61, 7.9%), previously failed grafts (n=61, 7.9%), endothelial and stromal corneal dystrophies (n=28, 3.6%), and trachoma keratopathy (n=26, 3.3%). Other indications including Terrien's marginal degeneration, post-LASIK keratectasia, trauma, chemical burns, and peripheral ulcerative keratitis constituted the rest of cases. Techniques of corneal transplantation included penetrating keratoplasty (n=607, 78.2%), deep anterior lamellar keratoplasty (n=108, 13.9%), conventional lamellar keratoplasty (n=44, 5.7%), automated lamellar therapeutic keratoplasty (n=8, 1.0%), and Descemet stripping endothelial keratoplasty (n=6, 0.8%) in descending order. The remaining cases were endothelial keratoplasty and sclerokeratoplasty.

Conclusion: In this study, keratoconus was the most common indication for penetrating keratoplasty which was the most prevalent technique of corneal transplantation. However, deep anterior lamellar keratoplasty is emerging as a growing alternative for corneal pathologies not involving the endothelium.

Keywords: Corneal Transplantation; Lamellar Keratoplasty; Penetrating Keratoplasty.

Figure 1

Mean age of patients in each subgroup of corneal pathologies. CHED, congenital hereditary endothelial dystrophy; FED, Fuchs’ endothelial dystrophy

Figure 2

Techniques of keratoplasty during the study period. PKP, penetrating keratoplasty; DALK, deep anterior lamellar keratoplasty; LK, lamellar keratoplasty; DSEK, Descemet stripping endothelial keratoplasty; KLAL, keratolimbal allograft; EKP, endothelial keratoplasty; ALTK, automated lamellar therapeutic keratoplasty; SKP, sclerokeratoplasty.