title: Development of Selective Lamellar Keratoplasty within an Asian Corneal Transplant Program: The Singapore Corneal Transplant Study (An American Ophthalmological Society Thesis).
abstract: To evaluate outcomes of anterior lamellar keratoplasty (ALK) and endothelial keratoplasty (EK) within the Singapore Corneal Transplant Study (SCTS), with the hypothesis that both ALK and EK are able to provide equivalent or improved clinical outcomes, compared to penetrating keratoplasty (PK), and to determine changing trends globally with other international databases.
  
  
  
  Clinical data on all transplants performed was derived from our SCTS database, a prospective national keratoplasty registry, and clinical outcomes (graft survival, endothelial cell loss, complications, visual acuity) were compared between PK, ALK, and EK. Global trends on indications and forms of keratoplasty performed in 2011/2012 were obtained from national keratoplasty or eye banking registries, corneal/ophthalmological societies, national eye banks, and national ophthalmic institutions.
  
  
  
  Global rates of EK surgery vary widely, from 52% (Sweden) to 0% (South Africa), with higher adoption by industrialized countries. ALK adoption rates similarly vary from 28.7% (China) to 1.0% (Philippines). SCTS data show high adoption rates in Singapore: EK 44% and ALK 28%. Our surgical modifications to big-bubble deep anterior lamellar keratoplasty (DALK) surgery resulted in visual outcomes matching PK, and a low conversion to PK of 2.1%, whereas our evolving approaches to donor insertion in Descemet's stripping automated endothelial keratoplasty (DSAEK) show significant reduction in 1-year postoperative endothelial cell loss rates from 60% (folding), to 22% to 30% (Sheets Glide), to 15% (EndoGlide inserter).
  
  
  
  Improvements in various forms of ALK and EK surgery can lead to better visual outcomes, longer graft survival, and reduced complications, as compared to PK. Global trends suggest adoption of these procedures at different rates.
authors.affiliation: Singapore National Eye Centre Singapore Eye Research Institute National University Health System, Singapore Duke-NUS Graduate Medical School Singapore and Nanyang Technological University, Singapore.
authors.forename: Donald
authors.initials: D
authors.lastname: Tan
authors.affiliation: Singapore National Eye Centre Singapore Eye Research Institute.
authors.forename: Marcus
authors.initials: M
authors.lastname: Ang
authors.affiliation: Singapore National Eye Centre Singapore Eye Research Institute.
authors.forename: Anshu
authors.initials: A
authors.lastname: Arundhati
authors.affiliation: Singapore National Eye Centre Singapore Eye Research Institute.
authors.forename: Wei-Boon
authors.initials: WB
authors.lastname: Khor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003316:Corneal Diseases / Q000601:surgery*; D055954:Corneal Endothelial Cell Loss; D016039:Corneal Transplantation / Q000379:methods* / Q000639:trends; D057111:Descemet Stripping Endothelial Keratoplasty / Q000379:methods; D004728:Endothelium, Corneal / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D015948:Keratoplasty, Penetrating / Q000379:methods; D008297:Male; D008875:Middle Aged; D016730:Program Development; D011446:Prospective Studies; D014792:Visual Acuity; D055815:Young Adult