Analysis of the changes in keratoplasty indications and preferred techniques.
BACKGROUND
Recently, novel techniques introduced to the field of corneal surgery, e.g. Descemet membrane endothelial keratoplasty (DMEK) and corneal crosslinking, extended the therapeutic options. Additionally contact lens fitting has developed new alternatives. We herein investigated, whether these techniques have affected volume and spectrum of indications of keratoplasties in both a center more specialized in treating Fuchs' dystrophy (center 1) and a second center that is more specialized in treating keratoconus (center 2).


METHODS
We retrospectively reviewed the waiting lists for indication, transplantation technique and the patients' travel distances to the hospital at both centers.


RESULTS
We reviewed a total of 3778 procedures. Fuchs' dystrophy increased at center 1 from 17% (42) to 44% (150) and from 13% (27) to 23% (62) at center 2. In center 1, DMEK increased from zero percent in 2010 to 51% in 2013. In center 2, DMEK was not performed until 2013. The percentage of patients with keratoconus slightly decreased from 15% (36) in 2009 vs. 12% (40) in 2013 in center 1. The respective percentages in center 2 were 28% (57) and 19% (51). In both centers, the patients' travel distances increased.


CONCLUSIONS
The results from center 1 suggest that DMEK might increase the total number of keratoplasties. The increase in travel distance suggests that this cannot be fully attributed to recruiting the less advanced patients from the hospital proximity. The increase is rather due to more referrals from other regions. The decrease of keratoconus patients in both centers is surprising and may be attributed to optimized contact lens fitting or even to the effect corneal crosslinking procedure.
Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Stefan J
SJ
Lang
Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.
Mona
M
Bischoff
Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Daniel
D
Böhringer
Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany.
Berthold
B
Seitz
Eye Center, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Thomas
T
Reinhard
D002391:Catchment Area, Health; D016039:Corneal Transplantation / Q000379:methods* / Q000706:statistics & numerical data*; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods / Q000706:statistics & numerical data; D005642:Fuchs' Endothelial Dystrophy / Q000601:surgery*; D005858:Germany; D006801:Humans; D007640:Keratoconus / Q000601:surgery*; D012189:Retrospective Studies