title: Changing trends in corneal graft surgery: a ten-year review.
abstract: OBJECTIVE
  To review indications and corneal tissue use for penetrating and lamellar surgery between 2002 and 2011.
  
  
  METHODS
  The surgical reports of corneal grafts performed during 2002-2011, using tissues supplied by the Eye Bank of Piedmont (Italy), were reviewed retrospectively. Patient demographic data, date of intervention, indication for surgery, and surgical technique used were recorded. Surgical techniques included penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK) and endothelial keratoplasty (EK). The χ (2) test was used to compare the distribution of indications and types of surgical technique used, for corneal grafts done during 2002-2006 versus those done during 2007-2011.
  
  
  RESULTS
  The number of corneal grafts increased by 30.7% from 2002-2006 to 2007-2011 (from 1567 to 2048). Comparing the two periods, both main indications and surgical techniques changed significantly. In 2007-2011, the proportion of interventions for aphakic/pseudophakic bullous keratopathy (from 16.8% to 21.3%), graft failure (from 16.4% to 19.1%) and Fuchs endothelial dystrophy (from 12.8% to 16.7%) all increased significantly (P<0.05), while those for keratoconus decreased significantly (from 35.6% to 27.3%; P<0.001). In 2007-2011, the proportion of PK decreased significantly (from 92.4% to 57.2%; P<0.001) while that of EK and DALK went from 0.4% to 30.2% (P<0.001) and from 7.2% to 12.6% (P<0.001) respectively.
  
  
  CONCLUSIONS
  During 2002-2011 the number of interventions increased significantly for corneal endothelial diseases and graft failure. The growing demand for interventions for these diseases corresponded to the widespread adoption of EK techniques. The use of DALK also increased, but more moderately than EK procedures.
authors.affiliation: Department of Surgical Sciences, Eye Clinic, University of Turin, Turin 10121, Italy.
authors.forename: Ugo
authors.initials: U
authors.lastname: de Sanctis
authors.affiliation: Department of Surgical Sciences, Eye Clinic, University of Turin, Turin 10121, Italy.
authors.forename: Camilla
authors.initials: C
authors.lastname: Alovisi
authors.affiliation: Ophthalmic Unit, Hospital of Ivrea, Ivrea 10015, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bauchiero
authors.affiliation: Ophthalmic Unit, Hospital Santa Croce e Carle, Cuneo 12100, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Caramello
authors.affiliation: Unit for Ocular Trauma, Turin Eye Hospital, Turin 10121, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Girotto
authors.affiliation: Unit for Ocular Trauma, Turin Eye Hospital, Turin 10121, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Panico
authors.affiliation: Department of Surgical Sciences, Eye Clinic, University of Turin, Turin 10121, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Vinai
authors.affiliation: Eye Bank of Piedmont, Città della Salute, Turin 10126, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Genzano
authors.affiliation: Department of Medical Sciences, University of Turin, Turin 10126, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Amoroso
authors.affiliation: Department of Surgical Sciences, Eye Clinic, University of Turin, Turin 10121, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Grignolo
keywords: indications for corneal graft; lamellar keratoplasty; penetrating keratoplasty