The Evolution of Corneal Transplantation

Abstract

BACKGROUND The aim of this study was to investigate the evolution of surgical methods in and leading indications for corneal transplantation from 2005 to 2016. MATERIAL AND METHODS Data from the corneal graft waiting list and from all keratoplasties carried out between 2005 and 2016 at the University Eye Hospital Tübingen were retrospectively evaluated. RESULTS A total of 1259 keratoplasties were performed between 2005 and 2016 at the University Eye Hospital Tübingen. The most common surgical indications for corneal transplantation were Fuchs endothelial corneal dystrophy (45.5%) and keratoconus (14.2%). The mean rate of corneal transplantations almost doubled from 71 keratoplasties per year in the first 6-year period to 139 keratoplasties per year in the second 6-year period (P=0.005). The number of penetrating keratoplasties remained similar. The number of Descemet membrane endothelial keratoplasties (DMEK) increased significantly from 2008 to 2016 (P<0.0001). One DMEK procedure was performed in 2008 (representing 1.4% of all transplantations), while 75 DMEK procedures were performed in 2016 (representing 60.5% of all transplantations) (P<0.0001). DMEK became the favored surgical method for endothelial disorders, exceeding penetrating keratoplasty in 2013. CONCLUSIONS Our study shows evolutionary changes in preferred corneal transplantation techniques and leading indications for keratoplasty from 2005 to 2016. Since its introduction a decade ago, DMEK is currently the golden standard in the management of corneal endothelial dysfunction.

Figure 1

Schematic overview displaying: (A) a virgin cornea and (B–F) different keratoplasty procedures: (B) PK, (C) Boston keratoprosthesis, (D) DALK, (E) DSAEK, and (F) DMEK.

Figure 2

This figure shows the distribution of corneal transplantations by technique (PK, DSAEK, DMEK, DALK, and Boston keratoprosthesis) of the 1259 keratoplasties performed from 2005 to 2016. Between 2005 and 2007, corneal transplantation was exclusively performed in the form of PK. The first endothelial keratoplasty (EK) was performed in 2008 using the DSAEK technique. DMEK quickly replaced DSAEK at the University Eye Hospital Tübingen and became and remains the preferred surgical technique for endothelial diseases, surpassing penetrating keratoplasty in 2013. DMEK increased significantly from 2008 to 2016 (P<0.0001).

Figure 3

This figure shows the distribution of the corneal graft waiting list with indications (Fuchs’ dystrophy, keratoconus, Bullous Keratopathy, trauma, rejection, and others) for corneal transplantation at the turn of the year from 2005 to 2016 in 936 cases. The leading surgical indications for corneal transplantation were Fuchs’ dystrophy (45.5%) and keratoconus (14.2%) throughout the study period. Since 2013, the rate of Fuchs’ dystrophy as a surgical indication for corneal transplantation increased significantly (P<0.0001).