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Changing Indications for Penetrating Keratoplasty in Greece, 1982–2006: A Multicenter Study

Siganos, Charalambos S MD, PhD; Tsiklis, Nikolaos S; Miltsakakis, Dimitrios G; Georgiadis, Nikolaos S; Georgiadou, Irene N; Kymionis, George D; Pallikaris, Ioannis G

doi: 10.1097/ICO.0b013e3181bd44a1
Clinical Science

Purpose: To evaluate the leading indications for penetrating keratoplasty (PKP) and their trends in Greece during the period 1982 to 2006.

Methods: Retrospective data review of 1,929 patients (2233 eyes) who underwent PKP in the period between 1982 and 2006 at three cornea transplantation units of three hospitals in Greece (Athens General Hospital, Heraklion University Hospital of Crete, and Thessaloniki University Hospital). Indications were classified into nine different groups: keratoconus, herpes simplex keratitis, microbial (nonviral) keratitis (fungal, bacterial, and acanthamoeba), aphakic/pseudophakic corneal edema, posttraumatic corneal scars, chemical/thermal injury, regraft, Fuchs' endothelial dystrophy, and other.

Results: The leading indications for PKP, in order of decreasing frequency, were aphakic/pseudophakic corneal edema (n = 649 [29.1%]), keratoconus (n = 580 [26%]), regraft (n = 265 [11.9%]), microbial (nonviral) keratitis (n = 188 [8.4%]), posttraumatic corneal scar (n = 171 [7.7%]), herpes simplex keratitis (n = 104 [4.6%]), Fuchs' endothelial dystrophy (n = 104 [4.6%]), chemical/thermal injury (n = 61 [2.7%]), and other (n = 111 [5%]). The prevalence of regrafts as an indication for PKP increased during the study period.

Conclusions: Aphakic/pseudophakic corneal edema was the most common indication for PKP in a multicenter series in Greece followed by keratoconus. The number of regrafts dramatically increased during the 25-year period.

From the *Ophthalmology Department, University of Crete, Crete, Greece; †Ophthalmology Department, General Hospital of Athens “G. Gennimatas,” Athens, Greece; and ‡Ophthalmology Department, Aristoteleion University of Thessaloniki, Thessaloniki, Greece.

Received for publication October 22, 2008; revision received July 9, 2009; accepted July 30, 2009.

Reprints: Charalambos S. Siganos, MD, PhD, Assistant Professor of Ophthalmology, University of Crete, Head of Cornea & Transplantation Service, Department of Ophthalmology, Heraklion University Hospital (PA.G.N.I), Crete 71110, Greece (e-mail:

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