title: Corneal transplantation activity over 7 years: changing trends for indications, patient demographics and surgical techniques from the Corneal Transplant Epidemiological Study (CORTES).
abstract: This study aims to examine evolving indications and changing trends for corneal transplantation in Italy. Corneal transplantations performed with donor tissues distributed by the Veneto Eye Bank Foundation between 2002 and 2008 were prospectively evaluated. Of the 13,173 keratoplasties performed on 11,337 patients, 10,742 (81.5%) were penetrating (PK), 1644 (12.5%) were anterior lamellar (ALK), and 787 (6.0%) were endothelial (EK). Keratoconus (42.5%), regraft (18.9%), and pseudophakic bullous keratopathy (PBK, 11.9%) were the leading indications for PK, with keratoconus (69.6%) and regraft (6.5%) showing higher indications for ALK, whereas pseudophakic bullous keratopathy (50.1%) and regraft (18.7%) were the major indications for EK. There was an overall decrease observed in corneal grafting for keratoconus (P = .0048) and an increase for PBK (P = .0653) and regrafting (P = .0137). These indications differed by age and gender. The number of keratoplasties over 7 years was stable (P = .2394), although the annual number of PKs declined by 34.0% (P = .0250), ALKs began to rise from 2005 (P = .0600), whereas EKs showed a huge growth, with their number tripling in 2007 and further doubling in 2008 (P = .0004). Leading indications for keratoplasty showed similar data that have been reported elsewhere for Western countries over the past few decades, albeit with a higher percentage of keratoconus. However, the overall number of keratoplasties for keratoconus was in decline, whereas regraft keratopathy and PKs increased due to the application of the newer surgical techniques for corneal grafting. This highlights an important shift in managing corneal diseases toward the application of selective and more conservative surgeries and changes in indications in corneal transplantation.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: A C
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: The Veneto Eye Bank Foundation, Venice, Italy. Electronic address: adriano.fasolo@fbov.it.
authors.forename: A
authors.initials: A
authors.lastname: Fasolo
authors.affiliation: Department of Information Engineering, University of Padova, Padova, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Capuzzo
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Fornea
authors.affiliation: Ophthalmic Unit, University Hospital, Verona, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Bellucci
authors.affiliation: Ophthalmic Unit, Villa Igea Hospital, Forlì, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Busin
authors.affiliation: Eye Clinic, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Marchini
authors.affiliation: Eye Clinic, Department of Neurological and Movement Sciences, University Hospital, Verona, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Pedrotti
authors.affiliation: The Veneto Eye Bank Foundation, Venice, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Ponzin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003316:Corneal Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D016039:Corneal Transplantation / Q000706:statistics & numerical data / Q000639:trends*; D003710:Demography; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome