Descemet's membrane endothelial keratoplasty is the predominant keratoplasty procedure in Germany since 2016: a report of the DOG-section cornea and its keratoplasty registry

Abstract

Background/aims: This retrospective multicentric panel study provides absolute numbers, types of and indications for corneal transplantation in Germany from 2011 to 2021 and sets them into the international context.

Methods: A questionnaire was sent to the 104 German ophthalmologic surgery departments and 93 (89%) provided their data.

Results: The number of reported keratoplasties more than doubled from 2011 (n=4474) to 2021 (n=8998). Lamellar keratoplasties (49% posterior (n=2883), 4% anterior (n=231)) surpassed penetrating keratoplasty (PKP, 47%, n=2721) for the first time in 2014. Since 2016, Descemet's membrane endothelial keratoplasty (DMEK) has become the predominant keratoplasty procedure in Germany. Its number increased by 1.5-fold from 3850 (2016) to 5812 (2021). Main indications in 2021 were Fuchs' endothelial corneal dystrophy (FECD, 43%), pseudophakic corneal decompensation (12%), repeated keratoplasty (11%), infections (7%), keratoconus (6%) and corneal scarring (4%, others: 9%). The PKP percentage decreased from 70.2% in 2011 (n=3141) to 31.7% in 2021 (n=2853). Descemet's stripping (automated) endothelial keratoplasties (DSAEKs) decreased to 1% in 2021 (n=74). 98.6% of all posterior lamellar keratoplasties were DMEKs in Germany in 2021. The number of deep anterior lamellar keratoplasties (DALKs) remained comparable from 2011 (n=269) to 2021 (n=251, 2.8%).

Conclusion: Main indications for corneal transplantation in Germany (2021) were FECD and pseudophakic corneal decompensation. DMEK is by far the predominant corneal transplantation procedure since 2016 followed by PKP, whose absolute number decreased only slightly during the decade from 2011 to 2021. DALK proportions remain low, but stable, whereas DSAEK decreased annually and plays a minor role in Germany.

Trial registration number: NCT03381794.

Keywords: cornea; treatment surgery.

Figure 1

Absolute number of keratoplasties in Germany from 2011 to 2021. Increasing number of reported keratoplasties in Germany from 2011 (n=4474) to a maximum of n=9197 in 2019 followed by a slight decrease to n=8998 in 2021. The x-axis shows year; y-axis, number of reported corneal transplantations.

Figure 2

Proportions of penetrating, anterior and posterior lamellar keratoplasties in Germany from 2011 to 2021. Proportions of penetrating keratoplasties (blue), deep anterior lamellar keratoplasties (red) and posterior lamellar keratoplasties (green) in Germany from 2011 to 2021. The x-axis shows year; y-axis, proportions of keratoplasty techniques.

Figure 3

Absolute number of penetrating, anterior and posterior lamellar keratoplasties in Germany from 2011 to 2021. Absolute number of penetrating keratoplasties (blue), deep anterior lamellar keratoplasties (red) and posterior lamellar keratoplasties (green) in Germany from 2011 to 2021. The x-axis shows year; y-axis, absolute number of keratoplasties.

Figure 4

Absolute number of posterior lamellar keratoplasties in Germany from 2013 to 2021. Absolute number of Descemet's stripping automated endothelial keratoplasty (DSAEK, blue) vs Descemet’s membrane endothelial keratoplasty (DMEK) from 2013 to 2021 in Germany. DSAEK decreasing from 507 (10%) in 2013 to 74 (1%) in 2021. DMEK increasing by 3.3-fold from 1773 (34%) in 2013 to 5812 (65%) in 2021. DSO (Descemet’s stripping only) and DWEK (Descemetorhexis without endothelial keratoplasty) were reported in 2021 for the first time.

Figure 5

Ten most active corneal transplantation centres in Germany (2021). The 10 most active corneal transplantation centres in Germany (2021) show a preponderance of posterior lamellar keratoplasties (exceptions: Homburg and Marburg).

Figure 6

Main indications for keratoplasties in Germany from 2017 to 2021. Reported main indications for penetrating and lamellar corneal transplantations in Germany from 2017 to 2021. FECD, Fuchs’ endothelial corneal dystrophy.

Figure 7

Waiting lists for corneal transplantation in Germany. Patients on waiting lists for corneal transplantation in Germany from 2017 to 2021, maximum of 5313 in 2018.