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Etiology of Global Corneal Blindness and Current Practices of Corneal Transplantation

A Focused Review

Mathews, Priya M. MD, MPH*,†; Lindsley, Kristina MS; Aldave, Anthony J. MD§; Akpek, Esen K. MD*

doi: 10.1097/ICO.0000000000001666

Purpose: The purpose of this focused review was to explore the etiologies of corneal blindness worldwide and compare them with the indications and type of keratoplasties (eg, full-thickness penetrating keratoplasty, anterior lamellar keratoplasty, or endothelial keratoplasty) performed.

Methods: A literature search of the articles published in the top 10 journals (based on the Altmetrics score) relevant to corneal transplantation within the past 20 years was performed to determine how the focus within corneal transplantation has changed over time. These data were compared with the prevalence and etiology of corneal blindness in each respective region worldwide.

Results: The leading etiologies of corneal blindness worldwide are primarily due to anterior corneal pathology with a normal endothelium, and the prevalence is highest in developing countries. In addition, the number and type of corneal transplantations performed globally indicate that current practices are disproportionately skewed in favor of endothelial keratoplasty, which is targeted for the pathology prevalent in developed countries. Despite the large number of individuals who would benefit from anterior lamellar keratoplasty, this technique seems to be infrequently performed.

Conclusions: Most corneal blindness worldwide is secondary to anterior corneal pathology because of infections and trauma. However, this does not align with the current trends and practices in the field of corneal transplantation. We discuss potential solutions to address the current leading causes of global corneal blindness, including increasing the number of anterior lamellar keratoplasties performed, using long-term preserved corneas by trained surgeons, and improving eye bank handling and distribution of procured tissues.

*The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD;

Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, NY;

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; and

§Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Correspondence: Esen K. Akpek, MD, Ocular Surface Diseases Clinic, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe St, Maumenee #317, Baltimore, MD 21287-9238 (e-mail:

E. K. Akpek serves as the national medical director of KeraLink International, which is the distributor of VisionGraft. The remaining authors have no funding or conflicts of interest to disclose.

Received February 06, 2018

Received in revised form April 29, 2018

Accepted May 06, 2018

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