title: Forty years of changing indications in penetrating keratoplasty in Israel.
abstract: OBJECTIVE
  To examine the leading indications for keratoplasty and identify the changing trends in the past 40 years in Israel.
  
  
  METHODS
  Pathology reports of all penetrating keratoplasties (PKPs) performed at Hadassah-Hebrew University Hospital from 1961 to 2000 were reviewed. We evaluated the indications for keratoplasty in each decade between the years 1961 and 2000.
  
  
  RESULTS
  During the 40-year period, a total of 1681 PKPs were performed. Keratoconus (n = 478, 28.4%) was the most common indication, followed by graft failure (n = 226, 13.4%), pseudophakic corneal edema (PCE) (n = 142, 8.4%), herpetic infections (n = 125, 7.4%), nonherpetic infections (n = 114, 6.8%), scarring (n = 113, 6.7%), and trauma (n = 110, 6.5%). The 7 groups account for approximately 77.5% of all keratoplasties performed. Ocular infections were the most common indications before 1970 and have been declining ever since. Keratoconus became the leading indication in the past 30 years. In the past decade, of 663 keratoplasties, keratoconus was the most common indication (56, 38.6%) followed by graft failures/rejections and PCE (the second most common indication between the years 1981 and 1990).
  
  
  CONCLUSIONS
  Keratoconus was the leading indication for keratoplasty in our series. There was a decreasing trend in PK for ocular herpetic infections during the decades. The rate of PCE decreased while failed graft became the second most common indication for PKP during the past decade.
authors.affiliation: Cornea and Refractive Surgery Service, Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Claudia
authors.initials: C
authors.lastname: Yahalom
authors.forename: Hadas
authors.initials: H
authors.lastname: Mechoulam
authors.forename: Abraham
authors.initials: A
authors.lastname: Solomon
authors.forename: Frederick D
authors.initials: FD
authors.lastname: Raiskup
authors.forename: Jacob
authors.initials: J
authors.lastname: Peer
authors.forename: Joseph
authors.initials: J
authors.lastname: Frucht-Pery
mesh_terms: D003315:Cornea / Q000473:pathology; D003316:Corneal Diseases / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015715:Corneal Edema / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D065306:Corneal Injuries; D005131:Eye Injuries / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D006084:Graft Rejection / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D016849:Keratitis, Herpetic / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D007640:Keratoconus / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D015948:Keratoplasty, Penetrating / Q000639:trends*; D012189:Retrospective Studies; D012720:Severity of Illness Index