title: Limitations of Keratoplasty in China: A Survey Analysis.
abstract: OBJECTIVE
  Each year, over 8,000 corneal transplantation surgeries are performed in China. Unlike developed countries, which have established standard requirements for operative experience for corneal specialists, little information exists on surgical training for keratoplasty in China. The aim of this study was to assess the keratoplasty experience of Chinese corneal specialists and to characterize their surgical patterns.
  
  
  METHODS
  One hundred and twenty-one corneal specialists in 16 provinces (65 cities) in China were invited to complete an anonymous survey at the 2014 Chinese Corneal Society annual meeting, which consisted of questions with single or multiple-choice answers. Demographics, the number and type of keratoplasties performed, and the perceived limiting factors for performing keratoplasties were analyzed.
  
  
  RESULTS
  An overwhelming 89% response rate was achieved. Of the 108 respondents, 76% worked in tertiary centers, and only 23% held a medical doctorate degree. Furthermore, 69% of the participants had received corneal fellowship training of less than one year. Only 71% were capable of keratoplasties. Among those doing keratoplasty, 68% performed less than 50 keratoplasties each year. Of the same group of keratoplasty surgeons, 88% of corneal specialists capable of keratoplasties had performed penetrating keratoplasties, 87% had performed lamellar keratoplasties, 12% had performed deep anterior lamellar keratoplasties, and 5% had performed Descemet's stripping endothelial keratoplasties. When questioned on the reasons for the low number of keratoplasties performed in China, the respondents deemed the following factors most important: lack of surgical training (71%), a shortage of donor supply (52%), and a lack of curricula (42%). A multivariate logistic regression analysis showed that corneal transplantation capabilities are significantly associated with responders' education levels and training time.
  
  
  CONCLUSIONS
  Keratoplasty surgery experience is suboptimal for Chinese corneal specialists. Penetrating and lamellar keratoplasties are the preferred surgical patterns. Our findings raise concerns about the adequacy of keratoplasty training in China.
authors.affiliation: Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Eye Institute of Xiamen University, Fujian, China; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Jiaxu
authors.initials: J
authors.lastname: Hong
authors.affiliation: Shandong Eye Hospital, Shandong Eye Institute, Qingdao, China.
authors.forename: Weiyun
authors.initials: W
authors.lastname: Shi
authors.affiliation: Eye Institute of Xiamen University, Fujian, China.
authors.forename: Zuguo
authors.initials: Z
authors.lastname: Liu
authors.affiliation: Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pineda
authors.affiliation: Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Xinhan
authors.initials: X
authors.lastname: Cui
authors.affiliation: Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Xinghuai
authors.initials: X
authors.lastname: Sun
authors.affiliation: Department of Ophthalmology and Visual Science, Eye, and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Jianjiang
authors.initials: J
authors.lastname: Xu
mesh_terms: D002681:China / Q000453:epidemiology; D003710:Demography; D005260:Female; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011795:Surveys and Questionnaires