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Evolving Indications for and Trends in Keratoplasty in British Columbia, Canada, From 2002 to 2011: A 10-Year Review

Tan, Johnson C. H. MBBS, FRCSEd (Ophth), FAMS; Holland, Simon P. MD, FRCSC; Dubord, Paul J. MD, FRCSC; Moloney, Gregory MBBS, FRCSC, FRANZCO; McCarthy, Martin MD, FRCSC; Yeung, Sonia N. MD, PhD, FRCSC

doi: 10.1097/ICO.0000000000000066
Clinical Science

Purpose: The aim of this study was to report the evolving indications for keratoplasty and the shift in the type of keratoplasty performed in British Columbia, Canada, over a 10-year period from 2002 to 2011.

Methods: This was a retrospective database review of all the records of corneal transplant tissues at the Eye Bank of British Columbia, Canada, from January 2002 to December 2011. The patient demographics, indications, and types of transplant performed were analyzed.

Results: A total of 4843 corneal transplants were performed in 3742 patients (1968 male and 1774 female) from January 2002 to December 2011. The number of keratoplasties performed ranged from 420 in 2008 to 578 in 2011. The top 4 indications over the 10-year period were Fuchs endothelial dystrophy (FED; 18.9%), aphakic/pseudophakic bullous keratopathy (17.4%), regraft (17.1%), and keratoconus (15.5%). Penetrating keratoplasty (PKP) accounted for 86.5% (4191 transplants) of all keratoplasties performed. Since the introduction of Descemet stripping automated endothelial keratoplasty (DSAEK) in 2007, there was a significant increase in the number of DSAEKs (P < 0.0001) performed and a statistical decline in the number of PKPs (P < 0.0001) performed. Despite only 30 deep anterior lamellar keratoplasties being performed, an increasing trend was observed after 2008 (P = 0.0087). A decreasing trend in PKPs and an increasing trend in DSAEKs were observed for surgeries performed for FED, aphakic/pseudophakic bullous keratopathy, and regraft.

Conclusions: FED has become the top indication for performing a keratoplasty over the 10-year period. There was a shift from PKP to DSAEK performed for endothelial failure. Although the number of deep anterior lamellar keratoplasty surgeries was small, there was a significant increasing trend.

*Department of Ophthalmology and Visual Sciences, Division of Cornea and External disease, University of British Columbia, Canada;

National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore;

Pacific Laser Eye Centre, Vancouver, Canada; and

§Eye Bank of British Columbia, Canada.

Reprints: Johnson C. H. Tan, Eye Care Centre, Cornea Unit, 2550 Willow St, Vancouver, BC, Canada V5Z 3N9 (e-mail:

Supported by Eye Bank of British Columbia, Canada.

S. P. Holland has received research support from Alcon Laboratories Inc and travel support from Allergan and Bausch & Lomb. The other authors have no funding or conflicts of interest to disclose.

Received August 03, 2013

Accepted December 06, 2013

Copyright © 2014 Wolters Kluwer Health, Inc. All rights reserved.