title: Impact of new lamellar techniques of keratoplasty on eye bank activity.
abstract: BACKGROUND
  Deep anterior lamellar keratoplasty (DALK) has become an increasingly popular alternative to penetrating keratoplasty in patients with stromal corneal pathologies. The main advantages of DALK are: prevention of long-term endothelial loss, elimination of allograft reaction and short topical steroid treatment with lower risks of glaucoma, cataract and infection. Because this technique enables surgeons to use corneal grafts with low endothelial density, the aim of this paper was to determine whether this type of innovation has had a significant impact on eye bank activity.
  
  
  METHODS
  We reviewed our corneal graft activity over a 40-month period and assessed the proportion of deep lamellar and penetrating keratoplasties. During the same period, we also evaluated our eye bank activity and recorded the utilisation of grafts with endothelium abnormalities, which were only suitable for lamellar techniques.
  
  
  RESULTS
  Deep lamellar keratoplasty represented 29.8% (85 out of 285) of corneal transplantations. Forty-eight percent of all corneas stored at the local eye bank were unsuitable for penetrating keratoplasty; 36.6% of those were not suitable for endothelial deficiencies. Among these, 72.7% were used for DALK and 27.3% were rejected. This permitted a 24.5% increase in corneal grafting activity. In contrast, Descemet's membrane was removed at the time of surgery in 12% of corneas with healthy endothelium, which was used for deep lamellar keratoplasty.
  
  
  CONCLUSIONS
  Deep anterior lamellar keratoplasty development and close collaboration between eye banks and surgeons can induce a significant increase in corneal grafting. This could be a partial solution in countries confronted with corneal graft shortages.
authors.affiliation: Department of Ophthalmology, Hôpital Charles Nicolle, Boulevard Gambetta, 76031 Cedex Rouen, France. Marc.Muraine@chu-rouen.fr
authors.forename: Marc
authors.initials: M
authors.lastname: Muraine
authors.forename: David
authors.initials: D
authors.lastname: Toubeau
authors.forename: Julie
authors.initials: J
authors.lastname: Gueudry
authors.forename: Gerard
authors.initials: G
authors.lastname: Brasseur
mesh_terms: D003315:Cornea; D003316:Corneal Diseases / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D046148:Donor Selection / Q000592:standards; D005125:Eye Banks / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000379:methods; D009926:Organ Preservation; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data