title: Current indications and surgical approaches to corneal transplants at the University of Toronto: A clinical-pathological study.
abstract: OBJECTIVE
  To determine the most common reasons and surgical approaches for corneal graft surgery at the Kensington Eye Institute (KEI), University of Toronto.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  A total of 229 consecutive corneal transplants performed at the KEI.
  
  
  METHODS
  Demographic, clinical, and pathological data on all 2012 and 2013 corneal transplants were collected.
  
  
  RESULTS
  The mean age for corneal transplants was 65 ± 16 years; 39% were full-thickness penetrating keratoplasties (PK) and 61% were partial-thickness. Graft failure (30%), infection (18%), and keratoconus (17%) were the leading indications for PK. Fuchs' dystrophy (40%) and bullous keratopathy (24%) were main causes for partial-thickness procedures. Among partial-thickness approaches, Descemet's stripping automated endothelial keratoplasty (DSAEK), deep anterior lamellar keratoplasty (DALK), and Descemet's membrane endothelial keratoplasty (DMEK) procedures accounted for 68%, 16%, and 16%, respectively. Fuchs' dystrophy (40%) and bullous keratopathy (33%) were the most common indications for DSAEK. Keratoconus (57%) and corneal scarring (35%) were the most common indications for DALK, whereas Fuchs' dystrophy (82%) accounted for most DMEK procedures. The most common reasons for all corneal grafts were Fuchs' dystrophy (25%), bullous keratopathy (21%), graft failure (17%), and keratoconus (12%).
  
  
  CONCLUSIONS
  Almost two-thirds of all corneal transplant procedures at the University of Toronto are partial thickness procedures. A failed graft was found to be the most common indication for full-thickness transplants. Fuchs' dystrophy was the most common indication for a partial-thickness approach, most often treated by DSAEK. Longitudinal data are needed to determine whether partial-thickness surgeries will improve graft survival and reduce the need for regraft.
authors.affiliation: Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont.
authors.forename: Ryan
authors.initials: R
authors.lastname: Le
authors.affiliation: Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Ophthalmology & Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, Ont.
authors.forename: Narain
authors.initials: N
authors.lastname: Yucel
authors.affiliation: Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Ophthalmology & Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, Ont.
authors.forename: Shireen
authors.initials: S
authors.lastname: Khattak
authors.affiliation: Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Ophthalmology & Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, Ont; Laboratory Medicine & Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, Ont; Ophthalmic Pathology Laboratory, University of Toronto, Toronto, Ont.
authors.forename: Yeni H
authors.initials: YH
authors.lastname: Yucel
authors.affiliation: Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Laboratory Medicine & Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, Ont.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Prud'homme
authors.affiliation: Keenan Research Centre for Biomedical Science at the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ont; Ophthalmology & Vision Sciences, St. Michael's Hospital, University of Toronto, Toronto, Ont; Laboratory Medicine & Pathobiology, St. Michael's Hospital, University of Toronto, Toronto, Ont. Electronic address: guptan@smh.ca.
authors.forename: Neeru
authors.initials: N
authors.lastname: Gupta
mesh_terms: D000368:Aged; D003315:Cornea / Q000000981:diagnostic imaging*; D003316:Corneal Diseases / Q000175:diagnosis / Q000601:surgery*; D016039:Corneal Transplantation / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D014495:Universities