title: Nationwide reduction in the number of corneal transplantations for keratoconus following the implementation of cross-linking.
abstract: OBJECTIVE
  Keratoconus is characterized by corneal ectasia and irregular astigmatism, which can lead to diminished vision and corneal scarring. Approximately 10-20% of patients with keratoconus eventually require a corneal transplant. Corneal cross-linking (CXL) is a relatively new treatment that may help prevent the need for corneal transplantation. Here, we investigated whether the introduction of CXL has reduced the number of corneal transplants performed annually.
  
  
  METHODS
  Data regarding the transplantation procedures performed in patients under the age of 50 years were extracted from the Dutch National Organ Transplant Registry. The number of corneal transplants performed prior to (i.e. in 2005 through 2007) and following the introduction of CXL (i.e. in 2012 through 2014) were compared. Furthermore, a trend analysis on annual keratoplasties over time was performed.
  
  
  RESULTS
  Approximately 25% fewer corneal transplants were performed in the 3-year period following the introduction of CXL compared to the 3-year period prior to the introduction of CXL (201 versus 269 transplants, respectively; p = 0.005). Age, gender and visual acuity were similar between the patient groups in the two time periods. Trend analysis also demonstrated a significant decrease in the amount of corneal transplants (p = 0.001).
  
  
  CONCLUSIONS
  Significantly fewer corneal transplants were performed for treating keratoconus following the nationwide introduction of CXL. This reduction suggests that corneal cross-linking can significantly reduce the need for corneal transplantation.
authors.affiliation: Department of Ophthalmology, Utrecht Cornea Research Group, University Medical Center Utrecht, Utrecht, The Netherlands. d.a.godefrooij@umcutrecht.nl.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Godefrooij
authors.affiliation: Department of Ophthalmology, Utrecht Cornea Research Group, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Renze
authors.initials: R
authors.lastname: Gans
authors.affiliation: Department of Ophthalmology, Utrecht Cornea Research Group, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Saskia M
authors.initials: SM
authors.lastname: Imhof
authors.affiliation: Department of Ophthalmology, Utrecht Cornea Research Group, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Robert P L
authors.initials: RP
authors.lastname: Wisse
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D019781:Corneal Topography; D016039:Corneal Transplantation / Q000639:trends*; D003432:Cross-Linking Reagents; D016208:Databases, Factual; D005260:Female; D006284:Health Plan Implementation; D006801:Humans; D007640:Keratoconus / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010778:Photochemotherapy / Q000379:methods*; D017319:Photosensitizing Agents / Q000627:therapeutic use*; D012042:Registries; D014466:Ultraviolet Rays
chemical_list: D003432:Cross-Linking Reagents; D017319:Photosensitizing Agents
keywords: corneal transplantation; cross-linking; keratoconus; keratoplasty